New Day, New Programs

With the implementation of OASIS-C Jan 1st, agencies have the ability to do an extreme makeover and position themselves for Pay for Performance (P4P). Yes, P4P will still come despite all the other changes that are occurring. The Demonstration project ended in December. Findings will be published in the near future.

April will be the last Caspers report until this fall. Home Health Compare will also not update for 6 months. What is done with OASIS-B is done. Quality reports are going to be wiped clean and the first full OASIS-C episodes will begin your new quality report tallies. Some quality measures will remain, others will be added.

So what should agencies focus on? Continue to do business as usual. Defiantly not! Agencies need to take a step back and look at their operations to see what is working and what is not. Are you a proactive agency or a reactive agency? Proactive agencies foresee the problems as they arise and put checks and balances in place to prevent rework and poor outcomes. Reactive agencies are always looking hindsight and trying to figure out what went wrong. They are so busy looking backwards they do not see the opportunities going forward.

Proactive agency need to take the first month or so of OASIS-C and see what their staff is doing well with and what they are not. What questions does your staff keep asking about? Do a small sample audit to see if that is a problem. If not, go onto the next question. Doing full audits on ever OASIS item is not practical. You are not going to be able to score 100% on all processes and quality scores nor does Medicare expect you to. Look at what your staff is struggling to understand. Educate on the big picture and continue to drill down overtime. We spent a decade with OASIS-B drilling down to find those deep correlations of risk adjustment, interrater reliability and began to think about P4P. It will take us awhile to understand the complexity of OASIS-C and how to best meet the process outcomes along with continuing to improve our quality outcomes.

So throw out those old quality audits. Burn them if it is therapeutic. Take a step back and take this opportunity to be proactive and foresee problems before they come. Change is good especially when in the name of quality and patient care. One of my favorite sayings is that “Quality Improvement is not a marathon, it is a death march”. Don’t kill yourself leaving the starting line.