Confused about OASIS? An expert answers questions

When home care professionals attended the legislative conference for the National Association of Home Care (NAHC) in Washington, DC, last March, one of the biggest questions on everyone's lips was: "When are OASIS regulations going to be finalized?"

The answer: "We're not sure yet."

But most Health Care Financing Administra tion (HCFA) officials say privately that the regulations will be released in June or July, with an effective date of September or October, says Kathryn Crisler, MS, RN, senior research associate at the Center for Health Services and Policy Research in Denver.

"HCFA says that the conditions will be ready this summer, and agencies will have to implement them 60 to 90 days after that," she says. "For agencies that haven't done anything on OASIS yet, that gives them a couple of months, anyway."

Crisler, whose organization pioneered OASIS for HCFA, says she gets a lot of questions about OASIS. The most common queries fall into three categories, she says:

1. Implications for organizations that have not yet prepared for OASIS.

"What it means to this group is that you have two options: You can go through all your clinical documentation and cut and paste and change items so that they are appropriate for the regulations," says Crisler, "or you can go out to one of the vendors that is now selling documentation that meets OASIS regulations."

Crisler says she knows of three organizations that sell the documentation: Briggs Corporation of Des Moines, IA [telephone: (515) 327-6400], Health Care Concepts of Memphis, TN [telephone: (901) 527-7701], and the Tennessee Association for Home Care in Nashville [telephone: (615) 885-3399].

"But if you purchase it, you still have to make sure that what you buy is appropriate for your organization, and that it meets all regulations," she warns.

2. Time-related questions.

Crisler says many of the questions she gets are about the time constraints OASIS will put on staff, in part because some organizations aren't familiar with OASIS, and also because those who are familiar have some irrational fears. There are also questions about when certain OASIS questions have to be answered.

"Some people have this idea that every question must be asked at every visit, but that's not true," she says. "Not all items need to be done at any one time. Some questions are about discharge; some are more appropriate to hospital admissions."

Crisler says her experience is that those organizations that already have comprehensive start-of-care documentation will not be affected by OASIS as greatly as they fear. "But those who don't, they will certainly feel a difference," she says.

OASIS requires learning period

It takes four to six times doing an OASIS assessment before a clinician feels comfortable, says Crisler. "During that learning period, it takes about 20 minutes extra for each assessment."

The additional time could be greater for clinicians with limited experience, or for those who have never done a comprehensive assessment.

3. OASIS' origin.

Many people view OASIS as the result of some HCFA staff member's nightmare, Crisler says. "But it really dates back to the 1980s, when HCFA was interested in outcomes of care and giving agencies some responsibility for their own performance improvement. It isn't malevolent, but is part of an effort by HCFA to partner with home care agencies. This is a different world now, and Operation Restore Trust and all the emphasis on fraud and abuse overshadow the original impetus behind OASIS."

There are other questions Crisler fields, like what will happen in terms of electronic transmission of data. "They say it will be ready in January, but I think that's a heroic goal. So much still has to be put in place. I wish I had an answer for that question."

For those who still have concerns about OASIS, HCFA is planning training in just about every state when the rules are finalized, she says. "It will be late for those agencies that haven't done anything," says Crisler, "but it will afford them a chance to make sure they are on the same page."

Change often brings emotional reactions, Crisler says. "But now agencies can see an improvement in outcomes. We had our year two outcomes reports a short while ago, and we saw that by our own efforts, there is improvement. You don't have to have some surveyor telling you what to improve in order to see positive change. That's what OASIS offers."