Month one of OASIS-C

Irrational rational

Illogic logic

Just a plain, what were they thinking?

I’m a big fan of the OASIS assessment because of the practical, efficient applications that result from the data collected; PPS calculation, quality measures and a standardized tool that every agency has to use. It intrigued me to learn the relationships of the specific questions and the complex calculations which either resulted in payment calculations or risk adjusted outcomes.

Learning these relationships over the years, we have learned small but critical improvements that were needed. M0700 ambulation/locomotion needed to be more specific in order to show the improvement a patient makes from using a walker to a single hand cane. Certain questions that were nonspecific and difficult to answer were eliminated, like M0280 Life Expectancy - likely hood a patient was going to live more than 6 months. For these details and other evidence based practices learned over the decade OASIS-C was created.

Studying and learning the changes with OASIS-C has been more of a learning curve than I would have expected. The relationships and skip patterns have been enough of a challenge. In particular, the wound section is particularly confusing. I like the clarification of what is considered a surgical wound, lesion etc. However, the manner which the questions are sequenced and the skip pattern are not efficient. For example, say a patient has only one stage II pressure ulcer. You have to answer six questions, to include M1320 which asks what the status of the most problematic pressure ulcer is. If there is only a stage II ulcer, the only answer can be 3 – non-healing. So why ask the question? What is the purpose? If it is to confuse the clinician and waste their time, they have succeeded. The risk adjustment calculations are fairly complex as they are. Why not just factor this in and eliminate that question for stage II ulcers?

OASIS-C was tested extensively prior to the approval of the final version. Apparently, not wasting the clinician’s time and having the skip pattern as efficient as possible, was not taken into consideration. When the rationale behind their logic is not clear, it appears to be very illogical.

Quality has been the name of the game for the last decade and efficiency will be for this decade. CMS missed their opportunity to set this standard. Based on CMS’s history of making changes, it will be several years before they make appropriate changes to correct their irrational logic. For now, all we can do is figure out the issues, educate the clinicians, and continue the long journey to better patient care.