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Posts from the ‘OASIS’ Category

May 11

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PPS – More than ICD-9 Coding

Clinical record review in the past several weeks has revealed that my clients have greatly improved their ICD-9 coding. It’s really no surprise. Coding classes are offered regularly and there are many great services out there to assist agencies with coding. And coding is critical to home health PPS. No one can deny that.

But what I have been seeing repeatedly is clinical records reflecting very high clinical scores and almost non-existent functional scores. It’s as though once the diagnosis coding is correct, nothing further in the OASIS data set is examined. This morning, for instance, I reviewed a report of a patient who has severe visual impairment, is short of breath with minimal exertion and has diabetic neuropathy. But, as it turns out, this patient is safe to dress by herself, including retrieving her own clothes. And by divine intervention, it is safe for her to bathe and toilet independently.

I have not looked at this patient. Nor would I mention this patient if this wasn’t so very typical of what I have been seeing in charts. And this is costing agencies!

Many nurses think that because a patient is forced by circumstance to perform these activities of daily living that they are able to do so safely and independently. And yet, OASIS instructions are very clear in that safety should always be considered in responding to the OASIS functional domain questions.

For more on making PPS work for you, check out the link to the right of the page. If you have any questions, please feel free to contact us at haydelconsulting@bellsouth.net or leave a comment below.

Apr 16

MO 770 OASIS Question about Telephone Usage

Recently on the Decision Health Home Care coding listserv a question was posed about MO770 – ability to use the telephone. The question sparked lively, intelligent debate and at the end of the day, I was on the fence about how the question should be answered for a patient with a laryngectomy who could use the text function on his telephone. My question to CMS as well the response is posted below.

On 4/15/09, we received the following email question: On a home health
listserv, a question has come up regarding the ability to use the
telephone.  The original question was about a man with a laryngectomy
who was unable to speak.  He was, however, able to use the text function
on his mobile telephone.

We are curious about how to answer MO770 for this patient.  It was
pointed out by one listserv participant that text capabilities weren’t
even a consideration when the original data set was written.  Can you
provide guidance?

CMS Response: M0770, Ability to Use Telephone, identifies the patient’s
ability to safely answer the phone, dial a number, and effectively use
the telephone to communicate. If a speech impaired patient can only
communicate using a phone equipped with texting functionality, response
“1” able to use a specially adapted telephone would be selected.

Should you have any question about this, consult the Decision Health Listserv where you will find a lot of people just as confused as me.

Apr 15

Blind Spot

When examining OASIS data for large groups and comparing it to care plans, there is one major discrepancy that never fails to raise a red flag: having a large number of patients with identified visual impairments compared to the number of careplans and clinical notes that address visual acuity.

Do this for your next staff meeting or case conference or any other occasion when you call your nurses in. Buy a pair of the strongest reading glasses you can find at the dollar store. Bring the glasses along with three scavenged pill bottles, a potato and a veggie peeler and a photograph of someone famous. As a younger staff member who functions without corrective lenses to wear the glasses and choose the medication bottle of your choice. Have her try to peel a potato and identify the photograph. Ask her to dial a number on the office phone.

After you have had your fun (and I assure you that it is fun!), ask the nurse if her attitude towards vision has changed. Is it possible that she is even more empathetic towards patients with impaired vision after the demonstration than before?

Even patients who can read pill bottles and do not reach the criteria for impaired vision in MO390 may have their life greatly enhanced by improved vision. Being able to really appreciate a photograph of a grandchild or being able to read comfortably can greatly add to the quality of life.

Low Vision programs are great for the severely impaired. But many patients can benefit from the following simple, less complicated approaches to improving vision:

  1. Upon assessing a patient with impaired vision, obtain their eye doctor’s number and coordinate a visit for them if it has been over six months.
  2. Place PRN meds in large freezer bags and write the name of them on the freezer bag with a Sharpee so that patients can readily identify Lasix or PRN pain pills.
  3. Assign someone in your office to investigate what vision services are available through your state’s Medicaid program.
  4. Strategically place lamps where they will most benefit patients. Use the florescent bulbs that put out a lot of light and very little heat.
  5. Buy black handtowels or linen napkins for use while patients are taking meds. That way any pills that drop are easily found.
  6. Ask family members to assist in buying clocks, scales, phones, remote controls, etc., with large numbers. Suggest that recorded books are borrowed from the library to provide the patient with ‘reading’ materials if the patient enjoys books.

 

Mar 22

Bundled Services and Outcomes

Bundling of Services

One legislative policy option for controlling postacute care costs is for Medicare to make a “bundled” payment to hospitals to cover episode costs.

This policy is being suggested by an economist Pete Welch in the Health and Human Services Division of the Congressional Budget Office. In short, bundled services would include all post acute care services for a period of thirty days to be included in the hospital DRG payment.  If post acute care services were ineffective, the financial risk to the hospital would be considerable.

It is only a ‘suggestion’ at this time but there is a very real possibility that Congress will take this suggestion seriously as a means to reduce post acute costs to Medicare. Whether this is good or bad depends on where you are sitting. But, as a consultant, my job isn’t to determine the suitability of such a proposal but rather to get clients ready for the possibility of bundled services.

It stands to reason that if hospitals are going to be paying for the first thirty days of care following a hospitalization they will have serious motivation to choose the best post acute care option with the best potential to meet the needs of the patient thereby reducing costs. Furthermore, the hospitals would have to justify their decisions.

Therefore, if I owned any type of facility that rendered care to patients following an inpatient stay, I would start now to ensure that my reported outcomes were as pristine as possible. And the outcome I would focus the most attention on is Acute Care Hospitalizations. If and when this comes to pass, I cannot see a hospital deliberately choosing an agency or facility that had a high rate of hospitalizations.

And if this doesn’t come to pass, there are millions of other reasons why preventing hospitalizations is a good thing. Ask any patient or family member of a patient who has been hospitalized lately how their lives were disrupted by an inpatient stay.

Mar 18

Ten Things about OASIS-C

  1. Say Goodbye to MO numbers. We now have M numbers.
  2. Most of the assessment numbers have changed completely from what we are used to.
  3. The question that has replaced MO440 about the presence of a wound or lesion has been modified to specify skin lesions and open wounds receiving intervention by the home health agency.
  4. Those of you expecting the time for assessments to be increased may be pleasantly surprised. With the exception of the transfer assessment, other OASIS assessments have been increased by one or two questions only.
  5. The date of referral is now an OASIS item. Could it be that someone is interested in seeing if your agency admits patients within 48 hours of referral as mandated by the Conditions of Participation?
  6. MO660 assessing the frequency of disruptive behavior problems has been assessed with M1745. M17454 reads: Frequency of Disruptive Behavior Symptoms (reported or observed) Any physical, verbal, or other disruptive/dangerous symptoms that are injurious to self or others or jeopardizes personal safety.
  7. The OASIS-C dataset asks about ‘formal’ screens for depression, pain and pressure ulcer risk. This does not refer to attire.
  8. Vaccination status will be assessed. Note that the flu season is October 31 through March 31. If your agency does not have a flu vaccination program then many assessments in January will reflect that your patient has not received a flu vaccine.
  9. Actual wound measurements are included in the dataset
  10. A comprehensive Care Management Grid is included as part of the assessment that covers ADL/IADLs, meds, treatments, equipment manager, supervision and advocacy.

We are preparing education material for agencies to help them get ready for OASIS-C. Look for updates next week. As always we welcome your comments and questions below in the comments section or by email to haydelconsulting@bellsouth.net.

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