Home Health OASIS Review

M1400: When is the patient dyspneic or noticeably Short of Breath?

Item intent: Identifies the level of exertion/activity that results in a patient’s dyspnea or shortness of breath

I’ll be straight up with you all right away. This item really, really frustrates me as a QA reviewer. This isn’t a new item, but it is very often scored incorrectly. Very often! I think there are some clinicians who have never put a response other than 0 down. And the really sad thing is that I’m certain many agencies have lost money on this specific item when it was tied to PPS reimbursement.

Not that I expect anyone to have the OASIS manual memorized, but the manual is very clear and helpful for accurately scoring this item. The CMS Q&As on this item are also helpful. I’m not going to copy it down here though. You should do the extra step and look it up if you want the details – or you can pay me to teach you how to score the OASIS better. That second part works out better for me!

Important points on this item

This is a “day of assessment” item, so it is supposed to assess the time of the assessment AND the 24 hours prior.
Non-ambulatory patients should still be assessed with a slight modification to the 0-4 scale. Just because they can’t ambulate doesn’t mean they don’t have dyspnea.
If they use supplemental O2 continuously, then assess them while they are using the O2. If they only use it intermittently/PRN, then they should be assessed WITHOUT the O2 on.

One last thing…

If the patient has a long list of respiratory conditions and is taking a dozen meds because they have a hard time breathing – please pause before automatically putting that 0 response in. I can’t tell you how many times I’ve seen the following in the narrative, “patient becomes easily short of breath” and even “patient has dyspnea with minimal exertion” and then the clinician marks response 0 in this item. “Dyspnea with minimal exertion” is literally the exact wording for response 3! Please know that if/when you do this, an angel loses its wings and dies a horrible, painful, dyspneic death.

OASIS-E Home Health Data Set

The draft version of OASIS-E is here. Lots of changes are coming!

It should be noted right away that this is the draft version and it is not finalized yet, so there are some changes that could happen before OASIS-E goes live on ~~January 1st of 2021~~ January 1st of 2022. (The COVID pandemic has pushed this back at least 1 year.) Everything in this post is current to the best of my knowledge as of the time of posting this. You can find and download all the OASIS data sets using this link to the CMS website. When OASIS-E becomes final, it will be uploaded on that page.

What’s new with OASIS-E?

Very little was changed for OASIS D-1, but that is not the case for the E version. Before I dive into that part, I’ll say up front that I know lots and lots of people will be disappointed and frustrated with how much has been added, but I appreciate how the OASIS has improved in capturing the social determinants of health in this new version. My wish and hope is that, before this is finalized, CMS will receive quality constructive feedback and consider removing more items to help reduce the length of this tool.

A Items

A1005 – Ethnicity – “Are you of Hispanic, Latino/a, or Spanish origin?” – 6 options to choose from.
A1010 – Race – This is an expanded version of the previous M0140 item, now with 15 options to choose from. Many of these are expansions of the Asian and Pacific Islander categories.
A1110 – Preferred language and need for an interpreter
A1250 – Transportation – A proprietary question from NACHC to assess lack of transportation
A2120, A2121, A2122, A2123, A2124 – Items for transfer or DC OASIS asking if the reconciled med list was passed on to the subsequent provider and patient and how it was transmitted for each.

B Items

B0200 – Hearing – 4 options
B1000 – Vision – Expanded version of the M1200 item, now with 5 options.
B1300 – Health Literacy – 6 options for this literacy screening question

C Items

C0100 – Determining if brief interview for the patient’s mental status should be completed (associated with C0200-C0500 items)
C0200 – Repetition of three words
C0300 – Temporal orientation
C0400 – Recall
C0500 – Score for total from C0200-C0400 items
C1310 – Signs and symptoms of delirium – from the Confusion Assessment Method (CAM)

D Items

D0150 – Patient mood interview – This is the previous PHQ-2 screening tool (as in M1730), but if they score above the threshold then it expands into the PHQ-9.
D0160 – Total score from D0150 for symptom frequency
D0700 – Social isolation – assesses for loneliness and social isolation – 6 response options

J Items

J0510 – Pain effect on sleep – 6 options
J0520 – Pain interfering with therapy – 6 options
J0530 – Pain interfering with daily activities – 6 options

K Items

K0520 – Nutritional approaches – Appears to partially be an expanded version of the previous M1030 item, which now includes texture modified and therapeutic diet options.

N Items

N0415 – High-risk drug use and indication – identifies several categories of high-risk meds and if they are indicated for the patient.

O Items

O0110 – Special treatments, procedures, etc. Includes cancer, respiratory, IV meds/access, and dialysis.

What hasn’t changed with OASIS-E?

Not very much, which surprised me. There are still all of the M1800s and GG items (GG0100-GG0170). The M1700s items remain the same, except where they are expanded with the C items. The basic intake M items are all still there and unchanged as far as I can tell (except where expanded for ethnicity and race), as well as the M1300s items, M1400, M1600s items, and M2000s items.

What we are left with is a much larger data collection set. I’ll be curious to learn how much time this will add to the average SOC and comprehensive assessment. The items that no longer exist (like M1200 and M1242) appear to have been replaced with new items. I don’t see any cases where an item has been completely removed without having been replaced or expanded upon.

In closing

What are your thoughts? Besides frustration, of course. The data nerd and SDoH parts of me really appreciate how OASIS-E will be a much more holistic, comprehensive tool. But the clinician part of me can’t help but focus on how much more time this will add. Also, if you see any errors in the above please let me know so I can correct it accordingly.

M0102: Physician Ordered SOC or ROC

Do you know when a date should be entered in M0102 versus M0104?

M0102 can be a very confusing item in the OASIS for some clinicians and agencies. What exactly is a physician-ordered start of care (or resumption of care) date? Some people make this item a lot more complicated than it needs to be. Let’s look at the item wording.

“If the physician indicated a specific start of care (resumption of care) date when the patient was referred for home health services, record the date specified.”

There is further guidance from CMS in the OASIS Guidance Manual on this item

“If the originally ordered start of care is delayed due to the patient’s condition or physician request (e.g. extended hospitalization), then the date specified on the updated/revised order to start home care services would be considered the date of physician-ordered start of care (resumption of care).”

There is one caveat though. This extended order needs to be received before the end of the 48 hour initial assessment time frame or before the date of the previously ordered SOC date. If the order is received after that time frame, response NA should be used in M0102 and the original referral date used for M0104.

What constitutes as an official physician-ordered SOC date?

The physician or physician designee needs to give a specific order that the SOC/ROC is to be done on a specific date. I can’t emphasize enough that it needs to be a specific date, it can’t be a range of dates or something vague. Anything other than a referral that directs the SOC/ROC to be on a specific date should be treated as a normal referral and the response in this item would be NA.

In general, most home care referrals do not have a specified SOC/ROC in them, though there may be certain physicians who typically order specific dates for certain types of patients. Here’s an example: A patient is being discharged home today, February 2nd, with an IV, feeding tube, or wound vac and the SOC needs to be on February 3rd, the day after discharge.

Please note that a patient request does not count as a date for this item. A date in this item needs to be directed by the physician. And if the physician lists a specific SOC date and the SOC isn’t performed on that date, there needs to be documentation to support why this didn’t happen. That’s always the best advice – make sure to thoroughly document everything and keep in communication with the physician and/or their office to help be as accurate as possible with this item.

Welcome to the Blog!

Thanks for checking out this educational blog/website. My plan is to use this blog to educate clinicians on how they can get better at completing CMS’s dreaded Outcome and Assessment Information Set, better known as OASIS. You can learn more about the history of this data collection tool/instrument from the CMS.gov website. I also plan on addressing other news related items in the industry, some of which will be clinically oriented and some non-clinical.

A little about me

I’m a physical therapist assistant (PTA) by training and have worked in the home health industry in one capacity or another for the last 6+ years. On the non-clinical side, I have worked in documentation review/quality assurance as an OASIS reviewer. I have a COS-C, which stands for Certificate for OASIS Specialist-Clinical and is through OASIS Answers. I’ll probably do a blog post in the future about getting my COS-C for those interested in going that route.

Why did I create this blog?

I started this blog as a way to address some of the most common errors that clinicians make when completing the OASIS, from SOC to discharge. I know documentation is the lease favorite part of the job for every practicing nurse and therapist in home health, but it is soooo important that this tool is used and filled out correctly. I really enjoy teaching and this blog will be a way to educate all home health clinicians on topics beyond the OASIS – topics relating to improving patient care, helpful resources for nurses and therapists, patient education, and more.

I’d love to hear from you

What questions do you have about the OASIS, clinical care in the home health setting, or anything else along those lines? Feel free to leave a comment below or connect with me on Twitter.