Our senior consultant, Lorie Owens, was recently quoted in Home Health Line’s feature on OASIS-D. We’ve included it below for tips on preparing for the new OASIS format. If you think you could use some hands-on assistance, we’re here for you. Lorie is an OASIS expert and has helped handfuls of home health providers fine tune their OASIS training and education. We know the appropriate timelines, teaching strategies and efficiency boosters to ensure your team is prepared. Just email us.
Start laying the groundwork now to lessen a productivity drain under OASIS-D
by: Kirsten Dize
With the added time home health experts anticipate OASIS-D will take and the amount of time many agencies expect to spend training, it’s a good idea to start preparing for the new version of the assessment now. More than 62% of the 139 respondents to a question on HHL’s 2018 Home Health Clinician Productivity Survey plan to spend at least three hours training for OASIS-D in the coming months. And about 22% plan to spend more than eight hours training.
The variation in the amount of time agencies plan to dedicate to training makes sense based on different approaches, says Arlynn Hansell, owner of Therapy and More, LLC in Cincinnati. Agencies that plan to only go over what is new on OASIS-D could reasonably spend two or three hours on training, while agencies that plan to refresh staff on other areas of the OASIS could spend as many as 20 hours on training, Hansell says.
Regardless, more heavy lifting on the managerial side may be necessary leading up to training, Hansell says. Managers and administrators will need to decide how the agency as a whole will handle collaboration on the new GG0170 (Mobility) and GG0130 (Self-care), Hansell notes (HHL 4/30/18). Agencies should make that decision now, Hansell says. Don’t save training for the last minute
Delaying training too long can make the transition to a new version of the OASIS more stressful than it needs to be and can impact overall productivity and job satisfaction for all staff, says Lorie Owens, senior consultant with Maxwell Healthcare Associates in White Bear Lake, Minn. “A lot of agencies wait to prepare until the last minute, and it makes the impact for those agencies more negative,” Owens says. With this in mind, Owens recommends starting now to collect OASIS-D training materials and prepare the education and training program you want to implement.
After reviewing industry comments about OASIS-D, CMS plans to post another draft version in July with an additional review period. A final draft is expected to be released in November — prior to final implementation on Jan. 1, 2019, according to CMS (HHL 6/4/18). While it may be a bit early to provide staff education on OASIS-D, your agency should put its plan in place and set dates to educate staff, Owens says. It’s also a good idea to take the time to re-train staff on any existing OASIS problem areas before training on what’s new. During August and September, re-educate staff on items currently on OASIS-C2 that will remain on OASIS-D, Owens recommends. Start to train on items new to OASIS-D starting in October, she adds. That timing is “based on when guidance is expected and keeping folks fresh for January implementation,” Owens says.
Agencies expect more time on OASIS-D CMS plans to remove 31 items from the OASIS assessment at certain time points and pare down two other items. As a result, CMS contends OASIS-D will be less burdensome for agencies than OASIS-C2. But while there are only six new items coming to OASIS-D, many in the industry still expect the assessment to take significantly more time than OASIS-C2 — in large part due to the addition of GG0170 and GG0130. Christina Crumbley, chief operating officer with Louisville, Ky.-based Signature Home Now, anticipates OASIS-D taking 30 to 45 minutes longer for her staff to complete than OASIS-C2 has at start of care (SOC). Crumbley fears assessments could take up to an hour longer depending upon how software vendors handle some of the changes. These estimates are consistent with public feedback on the OASIS-D draft (HHL 5/21/18). CMS has stated OASIS-D will take 47.7 minutes to complete at SOC, 40.5 minutes at resumption of care (ROC), 29.4 minutes at discharge, 23.7 minutes at followup and 7.8 minutes at transfer. But in reality it will take twice CMS’ estimate, Melissa Higdon, quality safety manager with Home Health Services & Home Care Coordination Johns Hopkins Home Care Group in Baltimore, notes in a comment submitted to CMS. And that’s “not including the time for patient education and treatment on the SOC/ROC visit,” Higdon commented. “We would strongly suggest that the team at CMS field test these with clinicians before implementing.”
The National Association for Home Care & Hospice (NAHC) also anticipates OASIS-D will take more time to complete than CMS expects. NAHC estimates OASIS-D will take 73.2 minutes to complete at SOC, 66 minutes at ROC, 39.1 minutes at follow-up and 54.9 minutes at discharge. Do this to improve training, productivity Audit existing OASIS problem areas. Look at star ratings and outcome reports — and your electronic medical records (EMR) system, if applicable — to help identify items your staff currently could assess better, Owens suggests. This will help you identify opportunities for education on items that are on OASIS-C2 and will remain on OASIS-D. Start training on a positive note. Open OASIS-D training by going over the items that will be removed effective Jan. 1, 2019, recommends D’ McCoy, director of clinical operations with Louisiana-based Professional Home Health Services. Doing so will help generate excitement and buy-in among staff. ó Simplify the training process by partnering with other providers.
Signature Home Now works closely with a skilled nursing facility (SNF), and a number of the agency’s physical therapists have previously worked in that setting, Crumbley says. Because GG0130 and GG0170 already are in place for SNFs as part of the IMPACT Act, Crumbley plans to involve these therapists in cross training nurses.
Be Healthy at Home in Buda, Texas, has a similarly strong working relationship with a nearby inpatient rehabilitation facility, according to Lori Rose, director of nurses. The agency plans to collaborate with that facility and involve it in training home health clinicians. ó Build in OASIS-D practice before the official implementation date.
At Professional Home Health Services, staff will fill out both OASIS-C2 and OASIS-D assessments for each patient starting in November, McCoy says. “I know it’s double work and they just love me to death when I have them do that,” McCoy says. But she finds it’s worth it to have staff get comfortable with the items before the new assessment is live. “I’d rather have that practice on a dummy that we will shred than have revenue difficulties with the changeover,” McCoy says. This approach has the added benefit of getting staff excited for the official implementation date, since that marks the end of completing two assessments for each patient. “Our productivity gaps are usually well before [implementation],” McCoy says. Consider changing work distribution. With the potential for reduced productivity tied to the implementation of OASIS-D, Crumbley plans to hire more licensed practical nurses (LPNs) to alleviate the burden on nurses. Currently Signature Home Now tasks nurses with handling everything from SOC to discharge for specific patients. In preparation for OASIS-D, the agency will create teams and utilize LPNs to support nurses by handling some of the visits. This will allow nurses to take on more patients to balance the cost of hiring new staff, Crumbley says.
*Article originally appeared in Home Health Line.