It’s Not Difficult to Satisfy Medicare.
Its not difficult to satisfy Medicare's Value-based Purchasing challenge to improve outcomes. For example, to show improvement for M1860 Ambulation/Locomotion, if the patient scores a '3' on admission (3. Able to walk only with the supervision or assistance of another person at all times), the patient needs to score a '2' or better on the OASIS-E1 Discharge. And going from a '3' to a '2' is 'all' that is necessary.
For an admission answer of '3. Able to walk only with supervision...', the goal requiring the least number of visits will be '2. Requires use of a twohanded device (for example, walker or crutches)'. This goal will still affect your VBP score positively but not 'break the bank' when it comes to utilization.
Attempting to go from a '3' to a '1' (1. With the use of a onehanded device (for example, cane, single crutch, hemi-walker...) will require at least twice as many visits (see below).
Remind Your Therapists.
Remind therapists that while Berg, TUG and Tinetti assessment tools are all valuable indicators of patient improvement, its the OASIS outcomes that matter most to the certified HHA. The OASIS outcomes are the primary driver of Medicare reimbursement and Star Ratings. Therapy's primary focus must be making sure the OASIS Discharge score is sustainable and legitimately better than the SOC score for all the M18XX ADL Items.
Therapists should be documenting the OASIS goal they plan to achieve plus the exercises and teaching to achieve the goal. For example if the goal s a '2', the goal is to graduate from 100% assistance to prn assistance/supervision and/or independence with a walker. Patient teaching and exercises should be included that achieves that goal.
OASIS E1: Improving M1860 Ambulation/Locomotion by just one OASIS level is a significant improvement.
There’s No ‘Extra Credit’ for Jumping 2 or More Levels.
Its important to remember that each answer to M1860 is a completely different level of functioning. For many patients it will be difficult to go from a '3' to a '0' and will likely require 2-3 times as many visits as going from a '3' to a '2'. If you are constricted by the number of visits because of the payer source, make sure the therapist modifies the OASIS E1 Discharge goal to the next level.
In some cases the the goal might not bring the necessary value to the patient’s overall improvement. See below.
Utilization Needs for M1860 Mobility Goals
From ‘1’ to ‘0’
CURRENT: (1) independent in ambulation/stairs with one-handed device.
THE GOAL: (0) Eliminate the need for a one-handed device.
THE BENEFIT: Patient doesn’t need a device for ambulation/stairs.
UTILIZATION NEEDED: 10-12 visits. The patient must be capable of learning multiple strategies to eliminate dependence on a one-handed device to safely ambulate/use stairs.
COMMENTS: The patient is safely ambulating with a one-handed device and the goal is to ambulate without the device. One might question the value of providing therapy to eliminate a device, where the patient is already independent. Also the utilization needed will be significant.
From ‘2’ to ‘1’
CURRENT: (2) requires a two-handed device or human supervision to ambulate/use stairs.
THE GOAL: (1) independence in ambulation/stairs with one-handed device.
THE BENEFIT: Patient doesn’t need a two-handed device for ambulation/stairs and the patient is less dependent on the caregiver.
UTILIZATION NEEDED: 10-12 visits. The patient must be capable of learning multiple strategies to eliminate dependence on a two-handed device or prn supervision - to safely ambulate/use stairs with a one-handed device.
From ‘3’ to ‘2’
CURRENT: (3) The patient currently requires 100% human assistance to ambulate/use stairs.
THE GOAL: Transition to (2) using a two-handed device OR supervision (as needed) to ambulate/use stairs.
THE BENEFIT: The patient is less dependent on the caregiver.
UTILIZATION NEEDED: 6-8 visits. The patient must be alert and oriented enough to learn how to safely ambulate/use stairs with a two-handed device and/or know when s/he needs supervision.
From ‘4’ to ‘3’
CURRENT: (4) The patient is independent in wheelchair mobility.
THE GOAL: (3) The patient is able to ambulate/use stairs with 100% assistance.
THE BENEFIT: Reduced risk of skin breakdown, improved endurance and range of motion.
UTILIZATION NEEDED: 7-8 visits. A caregiver must be available to assist the patient with ambulation/stairs as needed.
From ‘5’ to ‘4’
CURRENT: (5) The patient is dependent in wheelchair mobility.
THE GOAL: (4) The patient is independent in wheelchair mobility.
THE BENEFIT: Improved independence.
UTILIZATION NEEDED: 4-6 visits. The patient must be capable of transfer from bed to chair.
From ‘6’ to ‘5’
CURRENT: (6) The patient is confined to bed.
THE GOAL: (5) The patient is dependent in wheelchair mobility.
THE BENEFIT: Reduced risk of skin breakdown, improved endurance and range of motion.
UTILIZATION NEEDED: 4-6 visits. The patient must be capable of transfer from bed to chair.
Does Your Home Health Orientation Include These 11 Policies?
