OASIS Has 132 Questions. 44 Are Patient Risk Factors.
Medicare places great importance on managing risk factors.
There are 132 questions on OASIS E1 Start of Care and 44 (33%) are risk factor questions. Since the original version released in 1998, the majority of the OASIS assessment remains focused on the patient's functional ability and presence of unstable risk factors. Medicare places great importance on managing risk factors. These are conditions Medicare wants you to address to reduce the likelihood of ER visits and hospitalizations.
Some Risk Factors CAN and SHOULD be managed by the Office Clinical Manager, not by the Field Clinician. See below.
- Risk factors: 44 questions - 33% (see below)
- Functional Limitations: 41 - 30% (M18XX, GGXXX)
- Clinical conditions: 25 - 18% (M16XX, J05XX, M1400, M1060, M13XX)
- Medication Management: 17 - 13% (M20XX)
- Administrative - 3 - 1%
- Treatments - 2 - 1%
What Are Risk Factors and Why Do They Matter?
Risk factors are behavioral, social, home safety and economic conditions that affect the patient's ability to successfully manage a medical condition. Unstable risk factors can cause ER visits and/or hospitalizations. Example: if a patient is confused (M1700) s/he can't be taught medication management. Vision deficit (B1000)? Patient is at risk for falls, among other things. No transportation (A1250)? Can't make medical appointments.
Medicare Leaves the Clinical Assessment Up to Us.
Medicare expects us to perform a head-to-toe assessment but doesn't stipulate the exact questions. While there are general recommendations, the discretion is left to the HHA. Aside from a few questions that address clinical problems and wounds, the majority of the OASIS is devoted to risk factors and functional limitations.
"If the reason for home health is End Stage Renal Disease (insert any diagnosis), why am I required to address D0700 Social Isolation?"
Since Medicare asks us to assess it, we must assess and treat it. Social isolation negatively impacts health status and must be addressed by the home health clinician. Population health studies show social isolation, loneliness, and other aspects of social connection negatively affect the outcomes of certain clinical conditions and quality of life. Poor social relationships (e.g., social isolation, loneliness) increased the risk of developing coronary heart disease and stroke, independent of traditional cardiovascular disease risk factors (Valtorta et al., 2016a). Despite variability in the measurement of social isolation and loneliness across studies, poor social relationships were found to be associated with a 29 percent increase in risk of incident coronary heart disease and a 32 percent increase in the risk of stroke, and this was consistent across genders (Valtorta et al., 2016a).
"If we get only a few visits from the payer, how am I supposed to address risk factors?"
If the payer is traditional episodic Medicare you can re-certify as many times as is necessary to address all OASIS deficits including risk factors. If a commercial payer is authorizing only a handful of visits, report the problems - to both payer and physician - that you are unable to address because of the limit on utilization.
OASIS Risk Factors by Section
Section B Hearing, Speech, and Vision - 3 questions
B1300 Health Literacy, B0200 Hearing Deficit, B1000 Vision Deficit
Hearing and vision deficits are home safety risks. Home Health Intervention? Provide teaching guides for home safety related to vision and hearing impaired. Health literacy deficit? Provide teaching guides in the patient's language or enlist a caregiver that can understand the written and verbal patient instructions.
Section C Cognitive Patterns - 15 questions
M1700 Cognitive functioning, M1710 When confused, M1730 When anxious, C0100 Brief Interview for Mental Status, C1310 Signs and Symptoms of Delirium (from CAM©)
Confusion and cognitive deficits prevent the patient from learning prevention including medication management. Home Health Intervention? Make sure there's a teachable caregiver available to learn prevention.
Section D Mood - 21 questions; Section E Behavior - 2 questions
D0150 - D0160 Patient Mood Interview (PHQ-2 to 9); D0700 Social Isolation; M1740 Cognitive, Behavioral, and Psychiatric Symptoms that are demonstrated at least once a week; M1745 Frequency of Disruptive Behavior Symptoms (Reported or Observed):
Depression, anxiety, social isolation and behavioral problems can lead to a patient's hyper-perception of the need for medical care. This can cause higher utilization of services. Home Health Intervention? Provide the patient/caregiver with a list of community support resources and make sure the patient/caregiver successfully recalls preventive management of depression, anxiety and/or behavioral issues.
A1250 Transportation - 1 question
Transportation problems? Transportation services are often available in the community. Enlist the Case Manager to arrange for transportation services,
Some Risk Factors CAN and SHOULD be Managed by Office Clinical Manager.
Office clinicians can case management D0150 Depression, D0700 Social Isolation, A1250 Transportation, B1300 Health Literacy., M2102F Patient Supervision.
Does Your Home Health Orientation Include These 11 Policies?
