The year 2023 ushered in a new Outcome and Assessment Information Set (OASIS-E) for home health agencies (HHAs), as well as an expansion of the Home Health Value-Based Purchasing (HHVBP) reimbursement model (Centers for Medicare and Medicaid Services [CMS], 2023a). CMS analyzes these metrics to determine quality of care provided, reimbursement rates, and the clinical condition of the home healthcare patient population. HHAs have been collecting OASIS data for over 20 years. With the latest version, CMS made the most extensive revisions to the OASIS instrument and guidance manual since 1999 (CMS, 2023b). Twenty-seven items were added to OASIS-E and nine were retired. These revisions are major changes and agencies must develop innovative strategies to guide clinician decision making to ensure consistency in documenting the new items.
Assessment of cognitive function using the OASIS has remained a key focus of training and quality improvement, given the large number of patients with cognitive impairment who rely on home healthcare (Burgdorf et al., 2022). The Brief Interview for Mental Status (BIMS) was introduced in OASIS-E. and is collected with OASIS item C0200-C0500. Incorporating the BIMS in OASIS-E data collection, allows the clinician to create patient centered care plans that align with the patients cognitive abilities. The BIMS cue cards are designed to ensure consistency in assessment and documentation and are available on the CMS Home Health Quality Reporting Training page. Laminate the BIMS cue cards for all clinicians to make it durable and easily accessible.
In-person training led by the agency is necessary in addition to the OASIS webinars provided on the CMS website. In-person training should elicit feedback from clinicians about the CMS webinars. In-person training also provides a forum for clinicians to discuss other strategies that may prove more effective in navigating the BIMS during the home visit. Training should continue to emphasize the need to connect the dots throughout the assessment. For example, if a patient requires assistance for lower body dressing (M1820), it is likely the patient also requires assistance for toileting transferring (M1840). Invest in additional supervisory visits (Jones et al., 2017) which will help nurse managers better understand how clinicians are utilizing the BIMS tool during a home visit to screen and assess the cognitive status of patients.
Although the 2023 OASIS & HHVBP link payments to improved performance, the ongoing focus should be on supporting a home healthcare workforce that is equipped to delivery high-quality patient care, as well as provide clear documentation that reflects the acuity of patients. Home healthcare clinicians are key to the delivery of high-quality care for homebound patients. It has never been more important for clinicians to ensure that patient acuity is accurately reflected in clinical documentation. Managers and educators should continue to emphasize important messages about OASIS accuracy to ensure clinicians "paint the picture," and effectively tell the patient's story.
Nurses and therapists who provide care to homebound patients are a critically needed workforce to ensure continuity of home healthcare delivery. Fully supporting them is crucial to optimizing outcomes for the agency and patients.
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