As noted in a previous report, the Centers for Medicare & Medicaid Services has issued a draft version of the Outcome and Assessment Information Set (OASIS) C-1.
The proposed version – OASIS – C1 – reflects changes to accommodate coding of diagnoses using the ICD-10-CM coding set that take effect Oct 1, 2014. Additionally, revisions reflect issues raised by stakeholders – such as updating clinical concepts and modifying item wording and response categories to improve item clarity.
Further, CMS has removed items not currently used for payment, quality, or risk adjustment to reduce the burden associated with the OASIS data collection.
Below is a summary of the key changes to the OASIS C-1 assessment instrument.
ICD-10 related changes – Items in the OASIS-C that report patient diagnoses (M1010, M1016, M1020, M1022, and M1024) have been revised to accommodate ICD-10-CM coding. These items now have space to enter 7-digit codes, and references to prior ICD-9 “E” and “V” codes were removed.
Modifying and clarifying item wording – Wording changes designed to clarify questions, responses or directions were made to 44 items in OASIS-C1. These include clarification of data collection time periods and spelling out abbreviations such as “e.g.” and “i.e.” with clearer language such as “for example” and “specifically”.
Increased Harmonization – Column 2 on M1308 was eliminated at all time points and replaced with M1309 at Discharge to collect information on worsening pressure ulcer status using wording harmonized with other post-acute data collection instruments.
Updated clinical concepts – M1032, Risk for Hospitalization, was revised to collect data on factors that have been identified in the literature as predictive of hospitalization, and to order responses based on length of the appropriate look-back period.
Deleted at discharge – Collection of the following items will no longer occur at discharge since they are used only for risk adjustment of quality measures. They will continue to be collected at SOC and ROC.
- Item M1350 reports whether the patient has a skin lesion or open wound that is receiving intervention from the home health agency, other than a surgical wound, pressure or stasis ulcer.
- Item M1410 reports the types of respiratory treatments (oxygen, ventilator etc) the patient is receiving at home.
- Item M2110 reports how frequently the patient receives assistance with activities of daily living from caregivers other than the home health agency.
- Item M1012, Inpatient Procedures.
- Items M1310, M1312, and M1314, which report the length, width and depth of the pressure ulcer with the largest surface dimension.
- Item M2440- Reason patient was admitted to a nursing facility. Collected at the time of transfer from home health to a skilled nursing facility.
Note: When changes to an item substantively change the question or response options, a new item number has been assigned to the item.
Impact of Item Deletion – The impact of these changes on the number of items in the OASIS dataset is shown in Table 2.
Table 2: Number of Items in OASIS-C and C-1, by Assessment Reason/Timepoint
|Dataset||Total Items||Start of Care (SOC)||Resumption of Care (ROC)||Recertification/ Other Follow-up||Discharge||Death at Home|
Comments must be received by August 20, 2013.
The revised instrument, a table that compares the OASIS-C (Current Version) to the OASIS-C1 (Proposed Data Collection), and the supporting documentation can be found on CMS Paperwork Reduction Act (PRA) listing page.
To view, please click here and scroll to CMS-R-245.