Chapter 7 – New OASIS Items and Retired Items

OASIS E-1 is a nationally implemented instrument that has 27 new items. This update will add several new items and make the entire tool more reliable. In addition, the new instruments will add more letters to the OASIS score, improving its validity and reducing the need for re-tests.

OASIS-E is a nationally implemented instrument

The Centers for Medicare and Medicaid Services (CMS) delayed the implementation of the OASIS-E by two years, from January 1, 2021 to January 1, 2022. This is good news for home health agencies, as they have been undergoing significant disruption from COVID-19, a Public Health Emergency. The delay also allows home health agencies to continue with existing COVID-19 projects, such as developing new home care services.

In addition to improving communication between clinicians and patients, OASIS is important for assessing infection rates. This new instrument will help healthcare providers determine a course of treatment for a patient’s infection. It will also increase infection detection rates and monitor surgical wounds. This instrument is also free to use in hospitals and health systems nationwide. While there are still many questions about how to use OASIS, a key component is ensuring that it is used as intended.

To prepare for OASIS-E implementation, agencies must educate themselves on the new instrument. A technical assistance call was hosted by CMMI on Feb. 10th. You can access the recording of the call here. There are several resources related to the HHVBP, including the OASIS-E manual. CMS also finalized the implementation date for OASIS-E, which is now scheduled for Jan. 1, 2023. During the Public Health Emergency, the implementation date was delayed by a year to provide flexibility. However, the updated draft of OASIS-E can now be downloaded from the OASIS Data Sets webpage. The Office of Management and Budget must approve the instrument’s implementation.

Despite its high level of reliability, the OASIS-E has some limitations. It lacks consistency in the method of testing individual items and composites. Further, it lacks the number of studies to prove its validity. Therefore, researchers should be cautious when using OASIS data to investigate disparities and contributing factors. The validity of subscales is another area that needs to be evaluated. If a study fails to use OASIS-E data, researchers should consider conducting an independent review.

It has 27 new items and will retire 9 old items

The OASIS assessment tool has undergone an overhaul. It now includes an additional 27 items that were not previously covered. It will also retire 9 items. In addition to the new items, the OASIS Assessment Tool also requires agencies to indicate a current medication list to subsequent providers. The OASIS Assessment Tool is a useful reminder to stay on top of your OASIS training. But what exactly is new?

27 New Items:

A1005 – Ethnicity
A1010 – Race
A1100 – Language
A1250 – Transportation
A2120 – Provision of Current Reconciled Medication List to Subsequent Provider at Transfer
A2121 – Provision of Current Reconciled Medication List to Subsequent Provider @ D/C
A2122 – Route of Current Reconciled Medication List Transmission to Subsequent Provider
A2123 – Provision of Current Reconciled Medication List to Patient at Discharge
A2124 – Route of Current Reconciled Medication List Transmission to Patient

B0200 – Hearing
B1000 – Vision
B1300 – Health Literacy
C0100 – Should Brief Interview for Mental Status be Conducted
C0200 – Repetition of Three Words
C0300 – Temporal Orientation
C0400 – Recall
C0500 – BIMS Summary Score
C1310 – Signs and Symptoms of Delirium

D0150 – Patient Mood Interview
D0160 – Total Severity Score
D0700 – Social Isolation
J0510 – Pain Effect on Sleep
J0520 – Pain Interference with Therapy Activities
J0530 – Pain Interference with Day-to-Day Activities
K0520 – Nutritional Approaches
N0415 – High-Risk Drug Classes: Use and Indication
O0110 – Special Treatments, Procedures and Programs

CMS has released a draft version of the assessment, but OMB hasn’t approved it yet. However, it is expected to be approved this year. In the meantime, CMS released a crosswalk of OASIS-D to OASIS-E, which details the new assessment’s 27 new items. The final rule details these changes.

The OASIS-D1 and OASIS-E assessment forms will be used for reporting purposes. However, the new OASIS-E assessment form is designed to be more accurate and consistent. Its changes will make it easier for healthcare providers to compare their data and improve patient care. In addition, it will enable agencies to compare their quality metrics in a single, standardized form. The changes will also streamline the reporting process for all agencies.

9 Items To Be Retired:

M0140 – Race / Ethnicity
M1030 – Therapies at Home
M1051/M1056 – Pneumococcal Vaccine
M1200 – Vision
M1242 – Pain Interfering with Activity
M1730 – Depression Screening
M1910 – Fall Risk
M2016 – Patient / Caregiver Drug Education Intervention

It will have multiple letters

The new OASIS-E has 27 new items. For reference, the letters “E” and “M” represent different aspects of a patient’s health. For example, “M1720” stands for “When Anxious” and will be in Section C. The BIMS section will measure patients’ cognitive patterns and mood, while the “E” letter will be used for a more holistic view of a patient’s health.

OASIS-E is one of the most significant changes to the OASIS data set. To prepare for OASIS-E, organizations must understand its scope and what it entails. There are also several other changes. To understand what changes are made, read the OASIS E manual in the CMS website.

Agencies must decide where to get education and how to educate staff on the changes. Education sessions are ongoing at state and national association conferences and should start in October. During these sessions, staff should be educated on the new OASIS-E standards. It is imperative to begin these sessions as soon as possible.

It will improve validity

OASIS E will include new standardized patient assessment data elements that will assess pain, cognition, continence, and mobility. It will also assess falls. It will also have new sections for cognition and pain, and it will also have a new scale for pain.

The OASIS-E is scheduled to introduce new sections, including the BIMS section. BIMS measures cognitive patterns, behavioral responses, and mood. Once complete, OASIS-E will become mandatory for all HHAs and skilled care programs that accept Medicare. These changes will improve the validity of the assessment and the quality of care that the patients receive. You can use OASIS E in conjunction with a number of new tools and programs to help you improve the accuracy of your clinical trials.

In addition to addressing the accuracy and completeness of OASIS, these studies also need to consider the real-world practice context. The differences in productivity, case management, and agency incentives are known to affect assessor performance. For example, a recent study by Madigan et al. found discrepancies between the two scales, and that these discrepancies affected the outcome of the patient’s care. Home care agencies may be motivated to make patients appear more sick or injured than they are, which could affect the validity of the nationally implemented instrument.

It will improve employee engagement

While OASIS-E has been on the horizon for a while, the pandemic kept the implementation date off. Healthcare providers had other things to worry about, but now that the pandemic has passed, OASIS-E is top of mind.