The Benchmark Email

...benchmarks, strategies and ideas for improving your agency
A service of Fazzi Associates, Inc.

August 13, 2003

What OASIS Clinical Review Process
Works Best?

Question:
A year ago, the big thing about having accurate OASIS assessments was their affect on revenue per episode. Today, thanks to OBQI and Home Care Compare, accurate assessments affect not just your revenues, they also affect your quality outcomes, particularly those publicly reported in Home Care Compare. Two questions: Do most agencies have someone who reviews the OASIS assessments before they are locked in? And, is there one type of practice or model that tends to ensure better quality outcomes?

Answer:
The answer to your first question is easy. The answer is YES. In our most recent analysis of over 280 agencies that subscribe to Fazzi Associates' BestWorks™ National Best Practice Management Service, 90.71% of the agencies report they have someone review OASIS assessments before they are locked into the system. Most agencies understand that they must do everything possible to have accurate assessments.

The second question is a little more challenging. Of those who review the assessments. 92.5% use one of three models: nurse(s) with no other major responsibilities, nurse(s) with supervisory duties or nurse(s) responsible for QI/PI. The other 7.5% use an array of different models.

Here is where it gets a little more interesting. Through the BestWorks™ Service, we have taken the 30 OBQI risk adjusted items and have developed an index called the Risk Adjusted Outcome Index (RAOI). This index allows us to take subscribers' OBQI reports and put them on a scale from low to high. We then separated the group into three categories: Low RAOI, Average RAOI and High RAOI. The higher the RAOI, the better.

This is where systems like BestWorks™ become exciting and dynamic. Since we know which agencies have better OBQI quality outcomes and we know that there are three major OASIS review models being used, we were able to conduct a Best Practice Analysis to determine if there was a relationship between the model used and the RAOI. We did this by taking all the agencies who submitted OBQI reports and divided them into three groups: 1/3 with the highest RAOI scores, 1/3 with the average RAOI scores; and 1/3 with the lowest RAOI scores. Here's what we found.

What is interesting to note is more than half (51.5%) of the agencies with the lowest RAOI tend is use the Nurses with Supervisory Duties model. Those who have the highest RAOI are far less likely to use this model.

Does this mean that agencies that use this practice should immediately drop the practice and move to another model? Of course not! Some agencies with high RAOI use this model. It does however, mean that agencies who are scoring low with their OBQI scores and who use this model need to review their practices and see if they can improve their efforts or consider moving to another model.

One last point. When analyzing the practices of agencies that have High RAOI versus those with Low RAOI, it is clear that there are a number of major differences in practices between the two groups of agencies. There are also a number of different, significantly different, performance indicators. Here is one worth thinking about. Those agencies that get High RAOI tend to have higher "Average Case Mix Weight – Final Claim/Including LUPAs." The average of High RAOI: 1.11, Low RAOI: 1.04. They not only score better with their OBQI scores, thanks to differences in practice, they also have higher case mix weights.

One of the important things we have learned from the BestWorks™ Service is that there is a lot to be learned from agencies that score the best in key quality or financial outcome areas. Knowing what practices work best does lead to better results. This is one clear example.