Lynda Laff is a familiar and tremendously respected consultant. Home health agencies, hospices and home health care vendors across the country regularly call on her for insights and she has done a lot of work with us here at SHP. She brings a tremendous store of senior management knowledge, hands-on implementation experience and sheer industry "smarts" to every assignment.
How — and Why — Did You Get Those Scores?
In case you have been having trouble finding the new Home Health Compare website, click here and you can see how the new process measures are reported. Eventually, CMS will have the old Home Health Compare link automatically send you to this new site – but it is not fixed as of today.
If you have an outside data management company such as Strategic Healthcare Programs (SHP) and you have been analyzing your process measure data, good for you. Still, it is definitely worthwhile to see what is actually publicly reported and to compare your agency with your competitors in your market. I have viewed several agency outcomes and there seems to be a pattern forming.
1. Many agencies have low scores with all pain measures – especially with M1242. This is not a new item, but there have been changes in the answer options. The OASIS item included in the "frequency of pain Interfering with patient's activity or movement" may not be clearly understood by your staff. Make certain that your staff understands that this item is specifically asking about pain that interferes with activity or movement. This can include ambulation, transferring, eating, sleeping – anything requiring movement OR a function or activity. If the admitting clinician assesses the patient at a score of "1" and the discharging clinician (who may or may not be the same person) assesses a "2" because the patient has knee pain or back pain less often than daily, but in reality the pain does not interfere with activity – the patient will "decline" at discharge.
(M1242) Frequency of Pain Interfering with patient's activity or movement:
- 0 → Patient has no pain
- 1 → Patient has pain that does not interfere with activity or movement
- 2 → Less often than daily
- 3 → Daily, but not constantly
- 4 → All of the time
Time Points: SOC/ROC, F/U, D/C This OASIS-C item is often not scored correctly at the start of care
2. Many agencies are scoring low with Timely Initiation of Care and that outcome directly relates to the understanding of how to complete M0102 and M0104. Many agencies are not changing the OASIS M0104 referral date when the patient's hospital discharge is delayed.
3. Some agencies are having difficulty with the new heart failure measure "How often the home health team treated heart failure (weakening of the heart) patients' symptoms." This relates to heart failure follow up at M1510. It is likely that clinicians are confused as to how to answer this item.
(M1510) Heart Failure Follow-up: If patient has been diagnosed with heart failure and has exhibited symptoms indicative of heart failure since the previous OASIS assessment, what action(s) has (have) been taken to respond? (Mark all that apply.):
- 0 → No action taken
- 1 → Patient's physician (or other primary care practitioner) contacted the same day
- 2 → Patient advised to get emergency treatment (e.g., call 911 or go to emergency room)
- 3 → Implemented physician-ordered patient-specific established parameters for treatment
- 4 → Patient education or other clinical interventions
- 5 → Obtained change in care plan orders (e.g., increased monitoring by agency, change in visit frequency, Telehealth, etc.)
Time Points: Transfer, D/C
It is important that the clinicians understand that they should mark ALL that apply. If the agency has signed standing orders or best practices that are approved by the patient's physician, the clinician could answer "3." If you do not have physician approved best practices and the patient's condition warrants notifying the physician, the guidelines require that you notify the physician THE SAME DAY – not the end of the next calendar day as in one of the other OASIS items. A score of "1" is defined as follows:
- includes communication to the physician or primary care practitioner made by telephone, voicemail, electronic means, fax or any other means that appropriately conveys the message of patient status;
- is an appropriate response only if a physician responds to the agency communication with acknowledgment of receipt of information and/or further advice or instructions;
- additionally the communication must be from the physician or his (state approved) designee. Receiving information from clerical staff will not meet these guidelines.
I hope you will all log onto the Medicare Certified Home Health Compare website and view your new outcomes. The above items are just a few that seem to be giving agencies difficulty. Please let me know if you have any questions or if there is anything I can do to assist you and your clinicians with understanding OASIS-C.
Best regards,
Lynda Laff RN, BSN, COS-C
Laff Associates
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She has held several senior management positions and worked as a consultant for home health and hospice agencies. She has successful hands-on experience with Telehealth implementation, change management, clinical operations management and outcomes improvement in the home care setting.
Lynda served as a JCAHO home care and hospice registered nurse surveyor for 10 years. She has conducted workshops at state and national home health care and hospice forums on an array of subjects; including home care clinical models, management and operations, home care outcome improvement strategies, hospice QAPI compliance, Telehealth implementation and OASIS-C.
She was selected by the National Association for Home Care to develop and present workshops on PPS implementation in 2000 and 2007 and to represent NAHC in presentations on operational strategies to home health administrators in preparation for the 2008 CMS Home Health PPS. She has published articles in Caring Magazine, DecisionHealth, Clinical Nurse Supervisor, The ACHCThe Surveyor, and The Remington Report. She consults nationally with home health agencies, hospices and home health care vendors.