The Centers for Medicare and Medicaid Services (CMS) and the Robert Wood Johnson Foundation conducted research to develop, test, and refine outcome quality measures that could be used to improve the effectiveness of home care, thus the Outcomes and Assessment Information Set (OASIS) was born. Patient information derived from the OASIS led home health agencies (HHA) the ability to assess outcomes through Outcomes-based Quality Improvement (OBQI) measures and reports. Certain OASIS items are used to determine payment using the Home Health Prospective Payment System (PPS) process.

Changes to health care often come through legislation, including the current move from OASIS to OASIS-E. The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act included directives for CMS to increase standardized data collection across the continuum of care. Simply put, OASIS was revised to include sections and interviews that are included on the assessments used in skilled nursing facilities, in-patient rehab facilities, and long-term care hospitals. 

OASIS-E will go into effect January 1, 2023 and the patient’s voice will be heard through interviews that are important administratively and clinically. Therefore, it is imperative that your agency is prepared, and that those completing the OASIS-E understand the nuances and specificity required when conducting each interview. 

Administratively, the assessor is to allow the patient or proxy to self-report their race, ethnicity, and preferred language, as well as the impact on the lack of transportation to and from medical appointments, getting medication, or general needs.  

The Brief Interview for Mental Status (BIMS) requires the assessor to ask the interview questions in a very specific manner and order to assure cognition is accurately assessed; the patient is not to be mislabeled as more or less cognitively impaired than they are. The BIMS summary score reflects the level of cognitive impairment and should be considered when planning the patient’s care. The Patient Mood Interview (PHQ-2 to 9) also requires the interviewer to use specific techniques. This interview is not to be utilized to diagnose depression, but rather provide information as to whether the patient has indicators of depression, with the patient’s score reflecting the severity of the indicators. As with the BIMS, the results of the PHQ9 should be considered when planning for care.

There are three pain-focused interviews to help determine the amount of sleep a patient has lost because of pain, how often pain has limited the patient’s ability to participate in their rehab therapy sessions, and how often pain has limited the patient’s day-to-day activities. CMS clarifies they are not seeking a particular approach to pain management, but do stress that there are non-pharmacologic strategies to consider when developing the plan of care. 

Hearing the patient’s voice isn’t limited to the three interviews we have addressed. Other factors include race, ethnicity, preferred language, the impact on the lack of transportation to and from medical appointments, getting medication, or general needs, hearing, vision, health literacy, and social isolation. 

OASIS-E is not exclusive to patient interviews either; situations involving swallowing problems, high-risk medications, special treatment and procedures will all require clinician assessment. 

There have been some typographical and clarification changes, so click here  for the most up-to-date information.

References:
(1)    Outcome and Assessment Information Set OASIS-E Manual 5.16.2022 retrieved from Centers for Medicare and Medicaid Services Outcome and Assessment Information Set OASIS-E Manual (cms.gov) on September 22, 2022. 
(2)    Changes from Draft of 5-16/2022 to Final on 12/2/2022 retrieved December 20, 2022 from CMS.gov CMS Home Health Quality Reporting Program

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