Ask the right questions, get the right answers — deliver the right care.
That’s the essence of how home-based care providers are finding success under OASIS-E, which took effect January 1, 2023. Patient documentation requirements have changed in lockstep with the industry’s continued shift toward value-based care, with greater focus on each patient’s mental state as well as their social determinants of health (SDOH).
In a time when total dementia numbers are on the rise due to the boomer population, the new OASIS-E helps providers meet the moment, bringing the potential for improved care outcomes and a boosted bottom line.
Smart use of OASIS-E can also help providers stave off staffing churn. Staffing was a problem before the pandemic and has become a bigger one since. For reasons tied to both staff satisfaction and a healthy balance sheet, providers that get OASIS-E right will likely have a leg-up on staffing challenges.
“Everyone’s competing for caregivers,” says Jon Erik Higginbotham (RN, BSN), Vice President of Business Development and Clinical Analyst for Homecare Homebase, “and it’s even more cutthroat than it was before.”
For home-based care providers, the path to successful care outcomes, full reimbursement and staffing satisfaction all begins with OASIS data collection. That new focus on data raises the stakes on staffing turnover and training and brings more pressure to the daily work of home-based care nursing staff.
One of the largest concerns with the implementation of OASIS E was the potential to disrupt nursing staff by adding significant documentation time to start of care visits. “Before OASIS-E came to effect, most of the consulting groups were saying, ‘This is going to be significantly impactful,’” he says. The anticipation was potential four-hour starts of care and at least 45 minutes added on to OASIS-E visits.
“Because Homecare Homebase has a really robust and objective data set, it’s just not the case. On average, we’re seeing an increase of 1.2 minutes total documentation time,” he says. “That’s in-home and out-of-home documentation time for OASIS start-of-cares. The clinicians’ lives haven’t changed that much from documenting in OASIS-D to OASIS-E. That’s really exciting from our perspective.”
OASIS-E does not have to be the tedious, time-consuming process many predicted. Here are three best practices that home-health providers can take to succeed under OASIS-E.
Recognize that a nurse’s career has changed
While OASIS-E does not have to be unduly time-consuming, it is still complex, and it is integrated into nurses’ daily lives. That means that success starts with the nurses. And that means operators need to start by recognizing that nursing careers have changed.
“In the old world of nursing, you used to go to the hospital, work there for 30 years and retire. It’s not really working like that anymore,” Higginbotham says. “Now everyone is moving between different roles in nursing and therapy.”
As a result, providers have to work a bit harder to attract and retain great nurses. Reducing the time they have to spend on their OASIS data collection can be a key differentiator.
“I think OASIS education is the fundamental difference that can really impact a clinician’s daily life and operations as well as an organization’s efficiency and success with value-based purchasing,” he says. “All of that really centers around OASIS education.”
Technology is critical here. Homecare Homebase prompts nurses to complete documentation. While nurses might initially view this as a loss of control, the benefits far outweigh the downside.
“Operationally, it creates a culture of compliance, and it creates a culture of completion which is really important,” Higginbotham says. “We’re going to build in (compliance and validation) so that clinicians can’t send back these assessments that really don’t make sense holistically and are going to cause us to get OASIS rejections.”
Second, Homecare Homebase’s suite of tools helps home-based care providers paint the best possible picture of patients. “We have a tool called Disease State Management, where if a patient has a diagnosis of CHF, let’s say, I can guide my clinician to do certain things to ensure the patient’s safety.”
Deliver on work-life balance
Gathering data under OASIS-E is one of the challenges facing home-based care nurses today. But in a post-pandemic world, it’s far from the only one. The aforementioned ongoing battle for staff, Higginbotham says, is one, while another is the industry’s loss of a “psychological safety net” that held clinicians in place, working in home-based care.
Since the pandemic, providers need to focus more on their clinicians’ wellbeing.
“Mental health for our clinicians comes into play even more here because clinicians have a lot more opportunities to move and make more money in other arenas,” Higginbotham says.
By helping nursing staff with OASIS data collection, a home-based care provider checks two boxes: better care outcomes and happier staff members. That’s because the time they save their nurses is time those nurses can put back into other areas of their days.
“Employees are looking for more flexibility in their schedule and more flexibility in their personal life,” he says. “People are coming to home health and hospice for a little bit more flexibility because they are realizing that work-life balance is important.”
Understand the intent of PHQ questions
From the moment it was announced, OASIS-E was set to capture additional data that should give CMS a clearer picture of patient conditions and outcomes. The shift toward more attentive data collection is in keeping with other industry initiatives that are running in parallel to OASIS-E. The expansion of the Home Health Value-Based Purchasing Model is also highly dependent on careful data collection.
Higginbotham views the revised Patient Health Questionnaire (PHQ) assessment and its increased focus on SDOH as the top two changes of OASIS-E.
“Most payers will not reimburse the provider if they don’t ask those SDOH questions,” Higginbotham says. “What OASIS-E really did was force organizations at a high level to educate a little more intensely on OASIS so that nurses aren’t getting down these rabbit holes, which can really increase documentation time with the PHQ and social determinants of health.”
In short, OASIS is about giving CMS a clear view of each patient. Questions that assess a person’s ability to function mentally, not just physically are critical to that view. By being more precise in patient questions, and increasing focus on SDOH, providers will gather more accurate data, which will help them craft a more extensive and thorough plan of care. That improvement should, in theory, drive better outcomes and potentially greater payments.
“I’m really excited for the ability to start using the data sets that the acute care and ambulatory side have had for a long time with social determinants of health to model outcomes,” Higginbotham says. “As frustrating as I know it is as a clinician, I think eventually it’s going to improve outcomes for all of our patients that are being taken care of in the home.”
This article is sponsored by Homecare Homebase. Homecare Homebase is a software leader offering hosted, cloud-based solutions to streamline operations, simplify compliance and boost clinical and financial outcomes for home-based care agencies. Our customized mobile solutions enable real-time, wireless data exchange and communication between field clinicians, physicians and office staff for better care, more accurate reporting and improved revenue cycle management. For more information, visit hchb.com.
