Back to the future: OASIS is here, just in time for the year 2000 delay

Make education thorough and ongoing, experts say

You've known the Outcome and Assessment Information Set (OASIS) was coming for more than a year. But who has had time to implement OASIS when there have been so many other distractions, such as staff cutbacks, the interim payment system, and new compliance programs?

The Baltimore-based Health Care Financing Administration (HCFA) has funded several studies focusing on Outcomes-Based Quality Improvement, using the OASIS data set. Last year, the Balanced Budget Act of 1997 mandated that home care agencies move toward a prospective payment system (PPS). OASIS is the cornerstone of HCFA's plans to implement the PPS. It is designed to help agencies gather data on quality and outcomes. Home care agencies likely will have to begin collecting OASIS data by Oct. 1 and report the data to their state Medicare offices by Jan. 1 to avoid two problems:

· failure to comply with Medicare regulations;

· further complications for HCFA as it implements PPS.

HCFA officials said in July that the home care PPS probably will be delayed because the agency needs to focus on solving the year 2000 computer problem. However, HCFA appears to expect home care agencies to meet all the PPS deadlines, including gathering and reporting OASIS information, says Theresa Forster, vice president for policy of the National Association for Home Care (NAHC) in Washington, DC. (See related story, p. 131.)

NAHC recently sent an OASIS survey to about 8,000 home care agencies, and 1,600 responded, says Mary St. Pierre, BSN, director of regulatory affairs for NAHC. Of those 1,600, about one-third already were using OASIS, St. Pierre reports. "A lot of others are just waiting to see if it will go away," she quips.

OASIS will not go away, and its deadlines probably will not be delayed because it is a crucial step toward Medicare's PPS. "HCFA needs the OASIS data in order to finalize a prospective payment system," Forster says. "Yet right now, home care agencies are dealing with so much that if they can put off adding another straw to their tremendous load, then it will help them."

HCFA needs at least a year's worth of OASIS data from the home care industry before PPS will be ready to start, says Alan Wright, RN, MS, director of network development for the Visiting Nurses Association (VNA) of New England in Needham, MA.

The organization is a nonprofit membership association for VNAs in New England states. The association has assisted its membership agencies in developing OASIS tools, training home care staff on how to use the tools, and collecting OASIS data. So far, nearly 50 of the association's 68 VNA members have completed their OASIS assessment tools, and the remaining agencies are working on the tools, Wright says.

Wright spoke about OASIS in June at The National Managed Health Care Congress' Managed Post-Acute Care Conference in Phila delphia. Here are a few of the problems Wright predicts HCFA will have in implementing OASIS:

· Home care agencies already overwhelmed with switching to an interim payment system (IPS) may not have had time to learn how to implement OASIS data collection.

· HCFA already is behind on releasing its finalized rule on OASIS, and this still must go through a 60-day comment period before it is made final.

· HCFA will have to train public health employees in each state to collect OASIS data.

Your best strategy may be to follow the scout adage to "be prepared." Whether or not HCFA decides to delay the OASIS deadline, it is in your best interest to start teaching staff how to use the tool now, says Jeannette Sheehan, RN, MS, chief operating officer and clinical director of the Visiting Nurse Association of Middlesex East and the Visiting Nurse Hospice in Stoneham, MA. (See story on OASIS education, p. 131.)

"The sooner agencies start, the better because they can get all the errors out and make changes before it's mandated," Sheehan says.

Agencies will need to integrate OASIS data into their own assessment tools, develop the new forms, educate staff, and then start collecting the data on Oct. 1, St. Pierre says. "This will be tough for agencies that have done nothing so far with OASIS because it's not something you can do overnight," she adds.

And, as disheartening as it may be for home care administrators to hear, even if they succeed in meeting HCFA's OASIS deadlines and are ready to start reporting data on Jan. 1, there may be no one available to collect the information, says St. Pierre. HCFA has told the state Medicare offices to collect the OASIS data, but many of them are not ready, she notes.

"I spoke to a group of health care state surveyors, and when I said the OASIS deadline was Oct. 1, they asked, 'What year?' And when I said '1998,' they said, 'No way.'"

Yet implementing OASIS has its own rewards, several home care managers say. "It's nice for nurses to know they're not just gathering this information to send to HCFA," says Joanne O'Regan, MS, RN, vice president of admissions at the Affiliated Community Visiting Nurse Association Inc. in Rockland, MA.

"We use the information to manage care and as a performance improvement tool," O'Regan says. Eight VNAs merged in July 1997 to form the Affiliated Community VNA, which has 500 employees at three sites.

The Visiting Nurse Association of Central Connecticut Inc. in New Britain has developed an OASIS tool that has been accepted by its staff partly because it provides some clinically based information, and nurses can see if their patients are making progress, says David McKinnon, RN, supervisor of total quality improvement of the VNA, which serves 27 towns in central Connecticut.

Nurses at the Lee Visiting Nurse Association in Lee, MA, have found they get a better patient assessment by using an assessment tool that includes OASIS data, says Suzanne Hatch, BSN, MED, CPHQ, quality manager and staff development coordinator. The agency serves 40 communities in western Massachusetts. "The assessment will be more complete and standardized, and that alone improves patient care," Hatch says.