Home Health Agencies Failing to Master OASIS Skills

Home health agency staff do not have nearly as firm a grasp on the Outcome and Assessment Information Set (OASIS) as they should—and that could spell trouble for agencies nationwide.

On average, home health managers’ OASIS competencies come in at around 74%, according to data from Fazzi Associates, a Northampton, Massachusetts-based home care and hospice consulting, training, outsourcing, benchmarking and research firm. Auditors’ OASIS competencies come in at only 83% on average, Fazzi found.

Fazzi’s OASIS testing project measured the OASIS competencies of agency staff around the country through a survey of 57 questions covering all areas of OASIS, including a special focus on star rating and value-based purchasing items. OASIS is instrument/data collection tool the Centers for Medicare & Medicaid Services (CMS) uses to gather and report performance data by home health agencies.


“OASIS is the foundation for the entire clinical, operational, quality and reimbursement process in home care,” Fazzi Associates founder and Managing Partner Bob Fazzi said in the company’s June 2016 Benchmark Newsletter. “Given the critical nature of OASIS, these scores should be higher.”

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Among all agency staff, OASIS competencies were lowest in the neuro-emotional/behavioral area (24%), the therapy need/plan of care area (52%), and the respiratory status area (55%). Agency staff averaged a 67% competency for items with impact on quality, a 65% competency for items with financial impact and a 75% competency on items impacting value-based purchasing measures and star ratings, Fazzi found.


“The results are concerning because the test shows that there’s competency needed at every level of the clinical model,” Gina Mazza, partner and director of regulations and compliance at Fazzi, told Home Health Care News. But the results do show where—and with whom—agencies should spend the most time educating, she said.

Master the ropes

Managers, for instance, are the people responsible for supporting and educating the clinicians on OASIS. It makes sense, then, that both of their competencies average around 74%—but that’s nowhere near good enough, Mazza said.

“When the managers themselves have some learning opportunities, it’s an eye-opener,” she said.

Auditors, too, should have a much higher level of competency, Mazza said.

“Auditors’ competencies are at 83%, and to me that is way too low,” she explained. “The auditor is the final checker—83% is far too low for what we would term ‘experts’ in the situation.”

The brunt of the burden may seem to be on auditor’s backs, but that’s not the case, Mazza said.

“Of course, everyone in an agency is so busy, and there’s a reliance on the QA team to fix or catch the errors,” Mazza said. But that doesn’t mean auditors should be the only ones who know the OASIS ropes in and out.

“You’ve got to get back to the basics,” Mazza said. “Everyone at every level in that clinical model has to have strong expertise relating to a comprehensive OASIS assessment.”

An agency can sign up for an external audit to measure competencies among its staff and, from there, determine where best to focus education and resources to improve competencies, Mazza said.

“If there are issues in your agency, train folks,” Mazza advised. “OASIS isn’t going away.”

Written by Mary Kate Nelson

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