Fazzi Associates, Inc.

Question: Now that our clinicians have been using the OASIS-C instrument for the first half of the year, we'd like to refresh our training. Are there any areas you see in your testing that we may want to focus on?

Answer: First off, we want to say that holding "refresher" trainings is an excellent idea, and it is great that you have begun to implement them. Staying on top of your agency's progress is the only way to ensure continuous OASIS accuracy.

We had nearly 7,000 clinicians from 236 agencies complete our June OASIS Skills Assessment Test. Participating agencies ranged from small rural agencies to very large home care networks. In all, over 35 states were represented. We made many new discoveries and confirmed some ongoing problems.

One thing is clear: in order to do well, it is absolutely essential that all clinicians stay on top of the most current OASIS updates. The most frequently missed question, once again, was (M1910) Fall Risk Assessment (27.93% responded correctly.) According to Cindy Krafft MS, PT, COS-C, Director of Rehabilitation Consulting Services at Fazzi Associates, most clinicians missed this question because they may not have reviewed CMS’s updated Q&As. "The April Q&A indicates that when assessing fall risk using two tools - one that is validated and the rest not validated, the validated test is the only one that should be used to select the response to M1910. This would mean that a patient who scores fine on a TUG but has several other risk issues is scored as a ‘1’."

The second most frequently missed question was (M1730) Depression Screenings (28.39% responded correctly). According to Rhonda Will, RN, BS, COS-C, HCS-D, Assistant Director Home Care Quality Institute at Fazzi Associates, this is a problem area many clinicians struggle with “due to a misunderstanding of what meets the criteria of a validated accurate assessment." While information in the testing scenario indicated depression, the clinician in the scenario failed to meet the exact criteria required for a "yes" response.

Other interesting insights:

	The average clinician score decreased from 78% in March to 75% in June, a clear indicator that recurring training that includes CMS's updated guidance is essential. Scores ranged from 32% - 100%.
	For the first time, managers scored the highest with an average of 81%. They were followed by auditors (79%), therapists (76%), and registered nurses (74%).
	Two agencies had average scores of 90% or higher (down from six in March). Twenty-two agencies averaged 80% - 89%.

As clinicians continue to use OASIS-C in their clinical practice, there is no doubt that even more discoveries will be unveiled that are sure to help agencies make improvements with their own assessments. One thing is clear, while overall scores are increasing, some specific areas are not improving.

What's most important is that you recognize these areas in your own agency and begin implementing a plan to make improvements. OASIS-C targeted trainings, whether online or on-site, are a perfect follow up to the general overview sessions you conducted last fall. You should also regularly assess your clinical skill levels on an agency-wide and individual basis to ensure that your trainings continue to target the areas where you need it most.