Healthcare Provider Solutions

Effective January 1, 2107, home health is facing full implementation of OASIS-C2. One of the biggest changes, with OASIS-C2, is the treatment of Stage 3 and 4 pressure ulcers when the wound has epithelialized. Prior to January 1, 2017, agencies were educated that if a patient has ever had a Stage 3 or Stage 4 Pressure ulcer that it was to be documented as such on the OASIS, even if the ulcer was currently “closed”.  Not only are we NOT doing this with OASIS-C2, the language has been updated  – now you can acknowledge “closed” or “open” ulcers by referring to them as “healed” or “unhealed”.  So what constitutes “healed” —-Once the pressure ulcer has fully granulated and the wound surface is completely covered with new epithelial tissue, the wound is considered to be closed, and will continue to remodel and increase in tensile strength. For the purposes of scoring the OASIS, the wound is considered healed at this point, and should no longer be reported as an unhealed pressure ulcer.

The reimbursement impact associated with this change could be quite profound for the individual patient episodes that it will affect:

M1308 in the chart above will be updated to reflect the new numbering of M1311, but the scores are the scores in the 2017 HH Proposed PPS Regulation.  Table 7 above represents the scale to determine the HHRG scoring.  As noted above a C3 is basically going to be the score when a Stage 3 or 4 pressure ulcer is documented on the OASIS for M1311 and M1324.

Obviously, agencies must follow OASIS Guidance and document as is appropriate for the patient, but agencies that specialize in wound care may be raising an eyebrow when realizing that this will effect reimbursement greatly.  The difference in reimbursement for a C1 vs. C3 is in the range of $450 -$550 per 60 day episode.  OUCH!!

HPS Alliance Members need to register today for the OASIS-C2 Update Webinar on November 18.