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For many home health clinicians, the OASIS (Outcome and Assessment Information Set) is a frequent source of dread. When staff are not adequately trained in OASIS, home health agencies face a cascade of issues, including increased staff turnover, administrative burden, inaccurate Medicare reimbursements, and ultimately, poorer patient outcomes.
Ensuring employees are well-versed with OASIS now includes new challenges, as ongoing workforce shortages mean agencies are increasingly hiring employees with no previous experience with OASIS. Now more than ever, organizations must invest in robust training programs and continuously evolve training strategies, industry experts told Home Health Care News.
Documentation, specifically the OASIS portion of comprehensive assessments, has a negative connotation for home health clinicians, according to Valarie Johnson, director of education and clinical integration at WellSky. Clinicians often feel “ill-prepared” for completing OASIS assessments and “dread” the time it takes to complete the evaluation and the subsequent communication with their agency.
“They dread the [quality assurance] QA cascade, the back and forth,” Johnson said. “So there can be some adversarial relationships around making sure OASIS is an accurate assessment. A lot of times, clinicians leave the home health industry, or they never want to get into the home health industry, because of the level of documentation that is required, including that OASIS assessment.”
WellSky is a technology company that provides software and expertise to clients, including home health and hospice franchises.
For home health and hospice provider Interim, one of the greatest risks of hiring someone without previous OASIS training is the potential for them to leave.
“There are always risks in hiring someone who doesn’t have experience,” Angela Rhoads, vice president of operations excellence at Interim Health, told HHCN. “It’s really about making sure that you’re giving them the right kind of training and the right kind of support to be successful. I think the biggest risk that you have is spending a lot of money on training someone for them to decide it’s just not for them.”
Sunrise, Florida-based Interim HealthCare operates over 330 franchise locations, offering home health, senior care, hospice, palliative care, pediatric care and medical staffing services. Its franchises provide 25 million hours of home care to 190,000 people annually.
Clinician experience, turnover, and the potential for a wasted investment are far from the only risks of insufficient experience and training. Issues with OASIS knowledge hold trickle-down effects for nearly every aspect of a home health operation, including payment, according to J’non Griffin, senior vice president at SimiTree.
“Inadequate OASIS responses can lead to poor outcomes and payment in agencies,” Griffin said. “In addition, turnover in staff and inexperienced field staff leads to an increased burden in the back office, including decreased productivity by QA staff who try to ensure an adequate assessment.”
SimiTree is a technology-enabled consulting platform for post-acute and behavioral health agencies, including services for OASIS.
Staffing trends
Lack of OASIS experience is a “historical issue” that is compounded by recently worsened workforce shortages, Griffin said.
Experts agreed that as the available pool of experienced clinicians becomes smaller and more sought after, agencies increasingly welcome new hires with less experience.
“Whenever I first got into this industry, you always wanted someone with two years of experience in home health,” Rhoads said. “Now you’ll see people more and more open, except for those leadership positions. They’ll still really try to get someone with a lot of experience there. We’re just having to look at how we capture that clinical base, and get them into home health.”
With high levels of turnover and clinician dissatisfaction in home health, agencies are now “hiring who they can hire,” Johnson said.
Even hiring a clinician with experience does not always guarantee the necessary level of OASIS expertise. Even if clinicians have experience with another home health agency, they may bring with them “bad habits” that are difficult to break.
Workforce shortages have also created an additional layer of complication for providers. Home health agencies often need their clinicians to care for patients, causing them to cut training short. This causes clinicians to feel less confident in their jobs and perpetuates clinician dissatisfaction, according to Johnson.
How agencies train clinicians today
Due to differing levels of experience with OASIS, there is no one-size-fits-all approach to training new employees. Operating a consistent and non-negotiable training framework that allows for some flexibility to accommodate employees’ learning styles and existing knowledge is crucial, Johnson said.
Interim provides its franchises with general processes and tools, and most of its franchises utilize its training system called LIFE, which stands for “Learning For Interim Franchise Excellence.” LIFE includes a basic orientation to OASIS and a few courses to familiarize new employees with OASIS. Then, most franchises allow employees to spend some time providing care in the home. After gaining some in-person experience, Interim offers a more comprehensive education on OASIS.
“We have modules that will walk them through the full OASIS education, very much based on the regulatory items and how to do that, with a focus on quality of care,” Rhoads said. “Then they also have the ability, with the way that we’ve designed the training, to do refreshers one-on-one, or even to assign more targeted refresher courses. The modules are broken down in such a way that if I’m really struggling with the best way to assess a specific area, I can retake that training.”
Interim’s corporate-created training is offered via asynchronous e-learning.
Industry-wide, OASIS WALK is one of the most used and trained methods for data collection, according to Johnson. It was designed to encourage watching and observing patients perform tasks rather than only asking patients questions, which can skew accuracy.
Some organizations are evolving the WALK method. WellSky has developed what it calls the “TROTT” method, which builds upon the data collection aspect of WALK to connect gathered information to patient care. The TROTT acronym stands for think, request, observe, translate and team up and encourages clinicians to go beyond WALK to collaborate across disciplines and create a more holistic care plan.
This method provides a good framework for orientation, education, and training in home health, according to Johnson; however, experiential learning in the field is still required, regardless of the amount of in-person or online training.
“While asynchronous learning modules are important, and they have their place, they should be part of a broader training strategy,” Johnson said. “When you are selecting that type of learning piece of your framework, you want to look for really engaging modules that incorporate retention strategies throughout the module. Spreading any online or asynchronous type of learning and aligning it with the practical experiences is much more effective than a concentrated data dump.”
With OASIS training, agencies must focus on simplifying topics and creating easy-to-remember strategies to help decrease the “overwhelming” nature of OASIS.
The home health industry is increasingly understanding the importance of continuous and on-the-job training, according to Johnson. Still, she said she “doesn’t think, as an industry, we value training as much as we should.”
How agencies will train clinicians tomorrow
Keeping programs fresh and engaging, with plenty of in-field experience, is the gold standard for OASIS training.
Interim is currently on a “journey” to overhaul its OASIS training program by investing in “micro learning.” Creating smaller segments of training does require an investment from the agency, but each segment is also faster to produce, especially for agencies with a certified nurse educator on staff.
“Whenever you’re talking about creating an hour of learning … you can spend 10 to 12 hours creating that hour of learning,” Rhoads said. “That’s didactic, me just talking at you for an hour. So when you start talking about training sessions that are 10 minutes or less, you’re going to really reduce that. You’re focused on ‘What do I need to know to do my job?’ not ‘What do I need to know about everything that could go wrong or every certain situation?’ And you rely more on that experiential learning.”
Technology may increasingly become a part of OASIS training, according to Johnson.
Solutions powered by artificial intelligence (AI) are emerging to lessen the documentation burden for clinicians performing OASIS assessments, according to Johnson. These solutions may eventually lead to in-the-moment guidance for clinicians while they complete assessments. With new technology, agencies will also need to add additional training to get staff up to speed on the latest innovations.
To boost OASIS compliance now, agencies must commit to innovative, well-structured training programs.
“Don’t shortcut your investment in education, because it’s usually the first thing that gets cut and there are a lot of hidden costs from doing it that you don’t see,” Johnson said. “Listen to your learners, hear how they want to learn, and try to provide them with opportunities that are going to meet their needs. Then, just keep it fresh. Keep it fresh and provide multiple ways for people to learn, because we don’t all learn the same way.”
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