Fazzi Associates, Inc.

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Problems with Ensuring OASIS Accuracy

Question: Our nurses and therapists are excellent! They are well trained and dedicated, and most have been in home care for over five years. Like a number of others, your firm recommends annual OASIS audits and training. Do well trained staff really need this?

Answer: There is a reason why so many agencies now schedule annual OASIS audits and training. Like you, these agencies believe their clinical staff are well-trained and dedicated. But they also recognize that OASIS accuracy is a challenge, even for the most seasoned clinician. A recent study on the validity and reliability of OASIS helps to clarify this point.

In a study titled "Assessment of OASIS Reliability and Validity Using Several Methodological Approaches" conducted by the Center for Home Care Policy and Research and published in Home Health Care Services Quarterly (Vol. 24(3) 2005), researchers found “inconsistencies between several domains of OASIS and the CMS 485.” The researchers went on to say that the “consistently low reliability of some items still suggests that patient status may not be accurately reflected. Poor reliability impacts quality and reimbursement measures derived from these items.” The study went on to suggest additional work may need to be done on the OASIS instrument itself.

Here are the facts: OASIS shapes your plan of care. OASIS determines your level of reimbursement. OASIS leads to your OBQI and Home Health Compare quality scores. OASIS, under the emerging Pay-for-Performance environment, may help determine which agencies will receive bonuses and which may be penalized. And, from a financial perspective, if you underscore your OASIS assessment, look at what 1/100s of a difference in case mix weight means:

Fazzi Associates has conducted thousands (yes thousands) of patient audits in agencies throughout the country. Based on these audits, it’s clear that clinicians tend to underestimate the patient’s condition and ability. It is also clear that OASIS is a complex document.

There are two other things we can tell you. First, it’s true – most home care clinicians are dedicated, talented, passionate professionals who face clinical and productivity challenges day in and day out. These daily work challenges often lead some staff to lose their focus on OASIS, reading things too literally and selecting incorrect responses. Second, audits and trainings work. When done correctly and in a supportive way to clinicians, the impact is almost immediate – greater OASIS accuracy, higher case mix weights, and clinical staff with improved confidence and professional self-assurance.

Whether you do annual trainings and audits with Fazzi Associates or someone else, it is important to know that these services will greatly benefit your patients and clinicians alike… your two most important customer groups.