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Outcomes tool seen as valuable despite kinks
You’ve spent months studying and quizzing yourself for an upcoming professional licensing exam when your boss drops a bomb just days before the test. Your hospital’s requirement for all managers to pass the exam has been put on hold until further notice, the announcement states. How many of you, if faced with this scenario, would take it anyway?
Quite a few, apparently. Officials from several home health agencies have told Rehab Continuum Report they plan to collect OASIS data on Medi care patients despite an April 27 announcement from the Health Care Financing Administration (HCFA) that its implementation would be delayed indefinitely. The controversial patient assessment instrument first must clear several more regulatory hurdles, including the Paperwork Reduction Act, according to the HCFA announcement.
Most observers believe the agency will take at least several months to address the farther-reaching concerns Congress and others have about the dimensions of OASIS (Outcome and Assess ment Information Set). The home health industry has been protesting the size and scope of OASIS for months.
It was not until the extent of the OASIS collection requirements were splashed across the front page of The Washington Post in March that pressure on HCFA started to become unbearable. That story outlined the sensitive nature of the questions patients would be asked, such as the status of their personal finances and whether they have suicidal tendencies.
Regardless of these concerns, many home health agencies have decided to use the OASIS instrument as is to help measure their patient outcomes.
"There are some real opportunities from measuring outcomes through OASIS," says Karen Crockett Lindstrom, PT, MBA, divisional director of professional support services for SunPlus Home Health Services in Burbank, CA. Lindstrom also is president of the community home health section of the Alexandria, VA-based American Physical Therapy Association (APTA). SunPlus has received positive feedback from its clinicians on the way it integrated OASIS requirements into the company’s existing patient assessment tool.
As a result, SunPlus is allowing its agencies to choose one of two options regarding data collection. Agencies may use the patient assessment instrument when doing admission and discharge evaluations, but they do not have to fill out the forms at interim points as initially required by HCFA. Or agencies may use the assessment tool throughout the patient’s treatment, including at interim times. "Some agencies don’t want to go back and change things again three months later" after HCFA lifts the OASIS delay, Lindstrom says.
Keeping OASIS eases transition
Optima Homecare, a division of WakeMed Regional Hospital in Raleigh, NC, also has decided to maintain OASIS measurement in order to make the transition easier on staff. "HCFA will have some tool of outcomes measurement based on OASIS. Once you have it in place, and have gone through the training time with your staff, why pull it?" asks Dottie Oakes, MS, RN, executive director of orthopedics and neuroscience at Optima Homecare.
Oakes says the OASIS tool takes staff an average of 30 minutes to complete. OASIS can be a valuable tool because it helps place outcomes in the spotlight, she says. It is especially important in a prospective payment environment because it focuses on balancing cost-cutting and patient outcomes.
Automation of OASIS data also has worked well for the Visiting Nurse Association (VNA) of Southeast Michigan in Oak Park, MI. Although some agencies developed three OASIS forms — one each for use upon admissions, interim measurements, and discharge — VNA chose to develop one tool, says David Perry, MS, PT, manager of physical therapy and occupational therapy. Staff completing the forms simply skip the questions that are not required for interim measurements, which are clearly marked on the sample form.
Like Optima HomeCare, VNA did not want to use the advantages it gained in training staff to use the form, Perry says. He suggests hospital rehab departments that will have to adapt to using the MDS-PAC patient assessment tool work out bugs in the system through small pilot groups. VNA began planning for OASIS implementation more than a year before its requirement by doing just that.