Hello everyone, and welcome to our Monday Minute. Today I’d like to discuss with you one aspect of the Value Based Purchasing model that will be rolled out in January 2023, from the aspect of the OASIS items that will impact your Value Based Purchasing Total Performance Score.

The OASIS items that are included in Value Based Purchasing include the Dyspnea question M1400, Discharge to Community M2420, Improvement in Management of Oral Meds M2020. And then we have two Total Normalized Composite Change scores in Self Care and Mobility, with Mobility, including three items M1840, M1850, and M1860 and the Change in Self Care is M1800, M1810, M1820, M1830, M1845 and M1870.

The Normalized Composite Change scores are basically taking, for Mobility-three OASIS items, for Self Care-six OASIS items and in each of these composite situations, they are doing a calculation of the score for the individual OASIS item and then those are combined so that there is one composite score for Self Care and one for Mobility.

Basically, the composite change methodology is just to basically put everything on the same playing field. So if you look, for example, at the ambulation question, there are six levels of change that are possible if you go from the zero response on that OASIS to the number six response. Or if you start at six, which means the patient is non-ambulatory basically, and then improve them to a zero, which is the most independent, then you would have shown six levels of change.  In other OASIS items in that composite change section, they do not have six levels of possibility of change, because they don’t have six options to respond to on the OASIS. Because of that, if an ambulation question had three levels of change out of six possible, then that means you improved ambulation 50%. If you had a change in one of the other items that only had four possible options, and you changed that one, three levels, then that would be a 75% change in that patient, instead of a 50% change as it is with ambulation. So basically, they’re taking a percentage of the possible levels of change, as compared to the actual change that occurred, so that the percentages are put together to make more sense for the overall change in the patient’s mobility and in self care, in the item that requires six questions.

This is a change that occurred in the fourth year of the Value Based Purchasing demonstration that occurred over the course of five years in the nine Value Based Purchasing states. The prior system included all of those items that are in those composite measures now, then being individually scored OASIS items. So that was a really big change and do understand also, that they gave those composite change questions, a heavier weight because they included multiple items, while we were still in the demonstration.  For this nationwide rollout those composite scores, that will be one score again, with multiple items within it, that one score will carry the exact same weight as all of the other items in the calculation of the Total Performance Score. I shouldn’t say they carry the same weight, because they are weighted a little bit heavier, but they will only have the maximum point option of 10 for achievement or 9 for improvement, just like all the other items.

The OASIS items that we just listed again; dyspnea, discharged to community, improvement in oral meds, and then the two composite measures, those five OASIS related items will make up 35% of your Total Performance Score. So that is assuming that you have a score calculation for the claims based measure and that you have a score for HHCAHPS.   If you were not to have enough HHCAHPS scores, as we discussed in a previous Minute, you won’t have a calculation for HHCAHPS and therefore it would increase your OASIS impact to 50% of your total score and the claims based measures, the other 50%. As far as OASIS is concerned, and nothing has changed, in the fact that it impacts everything.  It impacts outcomes, your star ratings, now Value Based Purchasing and many of the items, especially the 1800 section, which currently impacts your day to day HIPPS code reimbursement.  Diligence with OASIS is absolutely necessary and I don’t have to tell any of you that. The reality of OASIS-E also becoming a factor in January, 2023, just makes the intensity of your OASIS education that more important as we begin to move through the remaining months of 2022 to prepare for 2023.

I hope this has given you a little insight today on the huge impact that these specific OASIS items will have with the Nationwide Value Based Purchasing Rollout. If you have any specific questions, please don’t hesitate to let us know. Please stay tuned as always to your State and National Associations for Home Care and Hospice. We hope to see you at a live conference soon. Have a great week.