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After much anticipation, OASIS-E finally went live at the start of January. So far, home health providers’ experiences have been a mixed bag.
Broadly, OASIS-E was implemented on Jan. 1, 2023, and lines up with the nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model.
Prior to the implementation of OASIS-E, many providers began preparation efforts for what would arguably be one of the biggest industry changes in recent years. It was crucial because payment is directly impacted by OASIS data collection.
At Apollo Medical, preparation meant getting the company’s clinical leaders certified in OASIS-E.
“We took OASIS-E very seriously,” Apollo Medical CEO Jason Growe told Home Health Care News. “We did that in our early fall of 2022, and then we made a real conscious effort to pull clinicians out of the field — investing in the time needed to prepare people for the changes that were coming in at the beginning of this year.”
Apollo Medical is an independent Medicare-certified home health agency that serves Missouri and Illinois. The company operates in roughly nine counties in each of these states, and averages roughly 250 patients at any given time.
At American Advantage Home Care, preparation meant leaning on state resources.
“Our state, Michigan Department of Health & Human Services, offered several webinars in the fourth quarter of 2022 for health care professionals, and administrators of organizations,” American Advantage Home Care President and CEO Cleamon Moorer told HHCN. “We signed up for a couple of the state’s 72-hour sessions. We also prepared with our current EMR provider. We were able to engage with them early on, and look at some of the differences in templates for OASIS-E versus OASIS-D.”
American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area, and has a census of 200 patients.
That preparation has served providers well.
But, for some providers, OASIS-E has still been a learning curve for their clinicians. That’s been the case at American Advantage Home Care.
“Some of the cases started by therapists required them to reach out to skilled-nurses for medication reconciliation throughout the assessment by keeping a nurse on the case for occasional PRN visits, if needed,” Moorer said.
That has forced a learning curve, which has had some positive impact, according to Moorer.
“It also fostered more collaboration, amongst the clinical team, to look at some of the new sections and areas of the OASIS-E template,” he said.
OASIS-E Challenges
When it comes to clinicians in the field, OASIS-E has been a mostly positive experience so far, according to Growe.
“I think our clinicians felt prepared for what they were going to see,” he said. “Anecdotally, it’s not taking a whole lot more time to go through the assessment with the patients than it was previously with OASIS-D.”
However, Growe noted that on the back-office side, the QA process has been taking a little bit longer. Apollo Medical is investing more time in working through this.
On its end, American Advantage Home Care has also recognized other challenges.
“As you look at some of the newer sections – the B sections – that now focus more on hearing, vision and health literacy, that particular focus has been somewhat challenging for some of our clinicians to assess because it does tie into cognitive patterns and levels,” Moorer said.
Section C, which has to do with interviewing patients for mental status, has also been an adjustment for clinicians.
“Challenge wise, some of our clinicians have spent longer amounts of time in the house on the initial start of care, and also spent additional time transferring their notes and documentation to the OASIS-E,” Moorer said.
American Advantage Home Care has elected to go with more start-of-care nurses who are focused on the OASIS, and then had subsequent visits followed up by LPNs, in many cases.
This enables the company to decrease some of the revisit load for some of their RNs, so these clinicians can focus more on the documentation.
Ultimately, Moorer believes that, in the midst of HHVBP, adjusting the intake process will be critical for providers.
“If your intake is solely clerical, you may want to consider adding clinical staff on the front end, whether that’s an LPN or a CNA, to give you a head start on what the hazard signs could be for that particular patient,” he said.
This may also alert a provider to whether a patient’s utilization may be higher than what the agency is able to provide or facilitate on the front end.
“As we look at [HHVBP], agencies that are able to achieve greater outcomes, with less utilization, less readmission and higher patient satisfaction — those agencies are going to get that 5% premium,” Moorer said. “When you calculate that across large numbers of services and high billing, it could make a difference between the success and failure of an agency.”
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