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ow that we are several years into use, what are some of the lessons learned about the Outcome and Assessment Information Set (OASIS) so far? Many clinicians and managers have come to realize how difficult it is to consistently produce accurate OASIS assessments. And achieving this is critical because it supports appropriate reimbursement and is the basis for the government’s quality of care measures published for all the leading home health agencies in every community in the United States. In this column, we will outline some of the resources many agencies are using to improve the accuracy of their OASIS assessments.
       One resource added recently by Centers for Medicare and Medicaid Services (CMS) is the OASIS Web-Based Training site, found at http://www.oasistraining.org./oasis11/upfront/U1.asp. This website contains a comprehensive, multimedia program available to anyone with web access. This training program explains why OASIS was developed and also provides clinicians with detailed instructions in each of the OASIS questions, including suggestions on how to effectively conduct an assessment. The goal is to help clinicians better understand the questions so that society benefits from more accurate and consistent OASIS datasets.
       The website is organized as a series of lessons that can be accessed in orderly sequence similar to conducting an assessment. Clinicians can also access specific sections to focus on particular questions and can even leave an electronic bookmark to return to a particular webpage later. The lessons are organized as interactive activities that include hypothetical scenarios and quizzes to help the clinician apply what he or she is learning. The lessons are further enhanced by the liberal use of photos and audio and video clips.
       Many home health agencies are finding this website helps with the orientation of clinicians new to home care and with annual competency testing. It also provides a dynamic reference tool when questions arise about a specific OASIS question. The site also provides links to other web-based resources as well as a link that allows participants to send questions to the CMS OASIS team. This tool is free of charge and demonstrates CMS’s commitment to supporting accurate OASIS datasets.
       Another source of help available to the industry is the report from the 3M National Integrity OASIS Project. 3M Home Health Systems, the National Association for Home Care (NAHC), and Fazzi Associates worked with over 50 of the nation’s top clinicians from nearly every state. Their task was to consider the most inconsistently answered OASIS questions, understand what contributed to the inconsistencies, and recommend assessment tips to improve OASIS responses. The report with their recommendations is available through NAHC or on the 3M Home Health Systems website at: http://www.3m.com/us/healthcare/his/products/home_health/index.jhtml.
       Some home health agencies have also addressed the issue of inconsistency among clinicians by designating specifically trained staff to perform all OASIS assessments. This allows a group of clinicians to concentrate on the OASIS questions and develop skills in obtaining valid responses. Many clinicians see OASIS assessments as one more time-consuming form that must be completed. They may not fully understand the skills required to obtain valid responses or the effect these assessments have on reimbursement and patient outcomes. An OASIS assessment clinician also provides consistency because the same person is completing the assessments at each required time point.
       There are also a variety of home care consultants, software programs, and tools that have been developed to assist agencies in addressing the issue of educating clinicians and focusing on consistency in OASIS responses.

Frequently Asked Questions
       Question: Can the physical therapist open a case where both nursing and therapy were ordered but the physical therapist is the most available to perform that open on a timely basis?
       Answer: No, the initial assessment must be completed by the registered nurse (RN), and this initial visit may or may not be billable depending on if there is a skill ordered that can be provided on the initial visit. If the only orders are for nursing to remove sutures or a venipuncture later in the course of care, the therapist will perform the first billable visit. The RN will then need to return within five days to complete the OASIS. At other time points, the OASIS may be completed by either therapy or the RN.
       Question: Does a central line (or subcutaneous infusion, epidural infusion, intrathecal infusion, or an insulin pump) count in responding to M0250?
       Answer: Only one question must be answered to determine whether these examples count as intravenous (IV) or infusion therapy—is the patient receiving such therapy at home? If the patient is receiving such therapy at home, then response 1 for M0250 would be appropriate.
       Question: I am unsure how to respond to M0810 (or M0820) if my patient has an epidural infusion of pain medication. Is this a subcutaneous infusion?
       Answer: In M0250, it was established that patients receiving epidural infusions or subcutaneous infusions were receiving IV/infusion therapy. Therefore, M0810 and M0820 should be answered. For M0810, the patient’s ability to set up, monitor, and change equipment reliably and safely, including adding appropriate fluids or medication, and his or her ability to clean/store/dispose of equipment and supplies should be assessed. NA would not be an appropriate response to M0810 in this situation.
       Question: I am looking for interpretation of an emergent doctor’s office visit for M0830 on the discharge OASIS. In our community, patients do not show up at the doctor’s office without an appointment. The home care nurse may call in the morning with a list of problems, and the doctor will schedule a same-day appointment to evaluate the patient. I think this is urgent if we are to use the same timeframe as admits to hospitals. Is it still an emergent care visit when answering M0830?
       Answer: Yes, the office visit for an emergent problem, which is scheduled less than 24 hours in advance, is considered an emergent care visit.
       Question: When a home health patient is admitted to a hospital for less than 48 hours of observation, do I need to fill out transfer and resumption of care when he returns home?
       Answer: This answer depends on whether or not the patient was officially admitted to the hospital. Each hospital varies in how long a patient can remain in observation before an admission is required, so you’ll have to check with the hospital. If the patient was never admitted to the facility, the encounter (observation) would be considered emergent care. If the patient was admitted and returns home, you’ll need to do the transfer and resumption of care.
       Question: Should we answer M0290 as “heavy smoking” when patients live in an environment with a smoker but the patients are not smokers themselves? They are exposed to sometimes continuous secondhand smoke, and it seems to be overlooking a significant risk factor.
       Answer: No, you should not. The focus of M0290 is on the patient’s smoking. The secondary smoke exposure would, however, be important to include in the clinical history documentation.
       Question: Our patient had a cyst in her elbow. She had surgery to have the cyst removed, and the incision was closed with sutures. Prior to receiving home health services, the incision was not healing, and home health was called in to perform wound care. I consider this removal of a cyst with a resulting incision a surgical wound; however, some staff are concerned that because it was removal of a cyst that it is not. Should I answer “yes” to M0482—does this patient have a surgical wound?
       Answer: Yes, you should because the incision from removal of the cyst would meet the definition for M0482, “Identifies the presence of any wound resulting from a surgical procedure.” In addition, the incision also contains sutures.
       Question: For a closed surgical incision that is fully epithelialized and free of necrosis or signs of infection, I know it should be considered fully granulating for M0488 when a well defined healing ridge can be palpated, typically between 7 and 10 days post-surgery. My question is, how early should I consider a surgical site to be a scar but no longer a wound (and therefore answer “no” to M0482)? In the past, I have said that if you recertify a patient you can call it a scar at that point, assuming that it is healed.
       Answer: Based on the Wound, Ostomy, and Continence Nurses Society’s OASIS Guidance Document, we suggest answering “no” to M0482 when the incision is fully epithelialized, free of necrosis or signs of infection, and the healing ridge has resolved. We are reluctant to give a specific timeframe because every patient is different and must be assessed individually. We think 60 days after surgery seems more than reasonable. Clinically, we call a closed surgical site a “scar” when it no longer needs any care and is only being assessed as part of the complete assessment. This seems prudent and clearer when explaining the rationale to most clinicians.
       Question: When answering M0488, would a surgical wound be considered “fully granulated” if it has a scab present?
       Answer: In terms of assessing surgical sites with scabs, every patient is different, but the authors are inclined to consider any surgical wound with attached necrotic material, including a scab, as “nonhealing” when answering M0488. The problem with scabs is that you really can’t know what is under them until they come off. Sometimes they surprise you. If a surgical site presents with a scab on admission, consider something like a hydrogel and gauze as a dressing rather than leaving it open to air. The scab will usually dissolve (by autolysis) in a few days allowing a more insightful assessment.
       If you have a question that you would like addressed in “OASIS: More Than Just an Assessment,” e-mail it to Renee Olszewski, Managing Editor, at rolszewski@hmpcommunications.com and we will address it in a future issue.