OASIS-E went into effect January 1, 2023, putting providers under pressure to keep up. While many home health providers are feeling comfortable with how they’ve adapted over the last year, this could be a false sense of security. Home health coding practices can be weighing on your organization without your knowledge. Thankfully, there are signs you can look out for to identify where you might be struggling and where you might need to focus to ensure your OASIS coding performance is the best it can be. 

What is OASIS Coding
The Outcome and Assessment Information Set (OASIS coding) was initially launched in 1999, with the purpose of reducing collection time, enhancing validity, and supporting standards in transitions between care settings. The OASIS coding system allows for the collection of about 100 items related to a home care recipient. These include:

  • Demographic information
  • Functional status
  • Clinical status
  • Service needs

Collection is completed for all Medicare and Medicaid, non-maternity and non-pediatric beneficiaries at the point of admission, discharge, transfer, and change in their condition. It is the responsibility of a home care clinician to collect the information through direct observation, interview, or working with a caregiver.

Signs Your OASIS Home Health Coding Needs Attention 
If you believe your organization might still be struggling with OASIS home health coding a year after launch, it’s worth looking for these signs. 

Clinician Competency Is Low
If you’re seeing variation in how your clinicians are performing assessments, this shouldn’t be surprising. This kind of variance often flows down through training methods, like using interviews instead of observation of functional status with delayed documentation. Fortunately, this issue can be addressed since there is solid understanding about the learning process and how it’s applied to building OASIS-E competency. 

All of your clinicians are unique and represent different learning styles, preferences, and even patterns of retention. It’s important to apply training that leverages repetition and association through short encounters where the information is presented over time. This will help you achieve the best outcomes among your staff. 

This means your orientations shouldn’t just be a one-off event. They need to be active and ongoing, giving your clinicians the opportunity to not only absorb knowledge but also apply it situationally to individual patient assessments in an efficient and consistent way. Make an effort to ensure that everyone involved is working from standardized materials and that competency measurement happens incrementally while being rooted in data [1]. 

Clinician Health is Suffering
Today’s home health clinicians are dealing with unprecedented levels of burnout and stress. And for some, OASIS coding might have added to the issue. 

Gathering OASIS coding data can be an extra burden, especially when layered on top of issues that already disrupt clinician well-being and work life balance. The home health industry has lost its “psychological safety net” that would keep clinicians in place. This means that, especially since the pandemic, providers should prioritize clinician well-being [2].  

This starts with helping staff with OASIS data collection. Consider giving employees more flexibility in their schedule and their personal life. This can be very effective in attracting workers who prioritize work-life balance. The payoff is that the result can be healthier, happier staff in addition to better outcomes. 

Ripples Are Already Showing Up
There are some predictable signs that you’re struggling with optimizing OASIS coding

Accuracy flows down through revenue and outcomes to risk, perceived acuity, and care planning. When acuity isn’t captured in documentation, you could be hindering your ability to reduce unnecessary hospitalization. Other signs include your clinicians dealing with challenges in helping patients stay home, and issues with data capture that are standing in the way of value-based care. 

If you’re seeing any of these signs, you know it’s time to take action on your OASIS home health coding and support your clinicians. 

You Have a Feedback Loop Problem
If you haven’t established a way to facilitate data-informed feedback that powers continuous improvement, you might have an issue with your OASIS home health coding

This type of feedback loop is ideally connected to learning needs. The benefit is that it can help uncover opportunities at both the individual and agency level to improve through the application of incremental and iterative learning. Remember that without both monitoring and reinforcement, your clinicians can forget a significant amount of what they’ve learned. This is especially true as your home health clinicians are going through their workday, interacting with patients, and assessing and collecting data. 

If you haven’t, consider working with coding and OASIS education experts to develop functional feedback loops and create insights into team performance. If you can quickly identify areas for improvement and individuals who need attention, you’ll save time and will enjoy improved outcomes. 

You’re Still Struggling with PHQ Questions
The Patient Health Questionnaire (PHQ) was revised to include increased focus on social determinants of health (SDOH) and align with initiatives that run parallel to OASIS-E. These questions though, support building a more complete picture of each patient.

If your clinicians are struggling to collect information on these questions, you could run the risk of reduced reimbursement. The challenge, though, is that these questions can genuinely increase documentation time. Make sure your clinicians know you are listening to their concerns and understand the additional pressures that have been put on them. 

Ultimately, properly navigating OASIS coding initiatives require help from multiple angles. As you look for ways to improve your OASIS results, consider outsourcing for assistance in clinical documentation, review, and coding level support.

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