Copyright 2005 Deborah Chisholm, LLC 1 
How OASIS Accuracy 
Impacts Quality 
Overcoming roadblocks to improved outcomes 
Presented by 
Debbie Chisholm, RN, BSN, CPHQ 
August 22, 2005 
Sponsored by Colorado Foundation for Medical Care

Copyright 2005 Deborah Chisholm, LLC 2 
Look Familiar? Look Familiar? 
Copyright 2005 Deborah Chisholm, LLC 3 
Objectives 
.. Discuss the role of data accuracy in quality 
initiatives 
.. Share regulatory requirements related to 
accuracy 
.. Discuss the business case for accurate data 
and the cost of inaccurate data 
.. Provide methods and resources for improving 
data accuracy 
Copyright 2005 Deborah Chisholm, LLC 4 
Data Collection – The Starting 
Line for OBQI 
Collect & transmit 
OASIS data 
Measure 
patient 
outcomes 
Interpret 
outcome 
reports 
Monitor 
action 
plan 
Implement 
action plan 
Develop 
action 
plan 
Identify 
problems/strengths 
& best practices 
Specify 
target 
outcome(s) 
Investigate 
care 
processes 
Starting 
Line 
Copyright 2005 Deborah Chisholm, LLC 5 
Data Collection – The Starting 
Line for OBQM 
Collect and 
transmit 
OASIS data 
Prioritize Adverse 
Event Outcome(s) 
Conduct Review 
Of Care 
Identify Problematic 
Care 
Develop Plan 
to Change Care 
Implement 
the Plan 
Monitor 
the Plan 
Determine if 
Change = 
Difference 
Starting 
Line

Copyright 2005 Deborah Chisholm, LLC 6 
The Value of Accurate Data 
.. Agencies can use OASIS data for: 
.. Assessment 
.. Care Planning 
.. Quality Improvement/Outcome Enhancement 
.. Patient Mix/Origin/Discharge Disposition 
.. Utilization/Cost/Resource Consumption Monitoring 
.. Marketing, staff/program development 
.. Feedback to Other Providers 
.. Voluntary Accreditation 
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The Value of Accurate Data 
.. CMS uses the OASIS data for: 
.. Public Reporting on Home Health Compare 
.. The Enhanced Survey Process 
.. Payment – PPS 
.. Program Integrity 
.. Quality 
.. OBQI 
.. OBQM/Adverse Events 
.. Case Mix Profile 
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Accuracy Requirement 
.. Accuracy is a regulatory requirement 
.. Medicare CoP Reporting OASIS Information, 
Standard - 484.20(b) Accuracy of Encoded 
OASIS data 
.. “The encoded OASIS data must accurately reflect the 
patient’s status at the time of assessment.” 
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Surveyor’s Accuracy Guidelines 
.. How does the agency monitor accuracy? 
.. Does the other information in the patient record 
contradict the OASIS? 
.. Does the OASIS collected during a new admission 
co-visit accurately reflect the patient’s status at the 
time of the assessment? 
.. Does the OASIS collected at a prior visit appear 
consistent with the health status of the patient? 
.. Considering normal progress/decline 
.. Natural progression of the disease

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Surveyor Probes 
.. Auditing clinical and data entry? 
.. Assuring consistency? 
.. Reviewing final validation reports? 
.. Identifying discrepancies? 
.. Addressing discrepancies? 
.. Correcting errors? 
.. Correction policy? 
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The Business Case for Data 
Accuracy 
.. Business case is the difference between what is 
gained and what it costs 
.. Data managers know accuracy is important 
.. Tough to make a business case for accuracy 
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The Business Case for Data 
Accuracy 
.. Business case for data quality assurance not always 
evident 
.. Example: Advertising 
.. Can’t know exact impact on business 
.. Do know if you don’t do it – you’ll lose business 
.. Cost of inaccurate data builds the business case 
.. Lost revenue, referrals, and avoidable 
costs 
Copyright 2005 Deborah Chisholm, LLC 13 
“I Love My Patients Home Care” 
OBQI Team 
.. Cost of OBQI team for one outcome 
.. 5 team members @ $30.00/hour avg. 
.. 5 two-hour meetings to develop plan = $1500 
.. 100 employees x 1 hour to be educated about 
plan = $3000 
.. No additional cost for ongoing monitoring and 
evaluation of plan 
.. $1500 + $3000 = $4500.00 Direct cost

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OBQI Plan of Action 
.. “I Love My Patients Home Care” chose Improvement 
in Transferring 
.. Agency outcome inferior to national reference and to 
self over time 
.. Statistically significant 
.. Large magnitude of difference 
.. Impacts large number of patients 
.. Significance level more significant than other outcomes 
.. Relevant to agency’s goals 
.. Publicly Reported Outcome 
.. Clinically relevant 
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Process & Results 
.. Care processes investigated 
.. Problem statement written 
.. Action Plan developed & implemented 
.. Plan monitored and re-evaluated 
.. Results not as impressive as hoped 
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Cost of Inaccurate Data 
.. Unknown factor 
.. No one at the agency understands how to 
accurately code M0690 Transferring 
.. Known - If ability varies, chose the response 
describing the patient’s ability more than 50% of the 
time 
.. Unknown – Chose response for the majority of 
activities 
.. If patient can independently transfer from bed 
to chair and on/off toilet, but not in/out of tub, 
then patient is scored “0” for M0690
(CMS OWBT FAQ) 
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Cost of Inaccurate Data 
.. Plan of Action developed on flawed, 
inaccurate data 
.. Patient outcomes don’t show true 
improvement because no one understood how 
to code accurately 
.. Still beneficial 
.. Standardizing care provision 
.. Educating staff regarding best practices

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Coding of M0690 
.. Impacts 
.. Public Reporting on Home Health Compare 
.. Enhanced Survey Process 
.. Case Mix Profile Report 
.. OBQI 
.. OBQM 
.. Payment 
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Impact of Inaccurate Data – OBQI 
Collect & transmit 
OASIS data 
Measure 
patient 
outcomes 
Interpret 
outcome 
reports 
Monitor 
action 
plan 
Implement 
action plan 
Develop 
action 
plan 
Identify 
problems/strengths 
& best practices 
Specify 
target 
outcome(s) Investigate 
care 
processes 
Road 
Block
Road 
Block 
Road 
Block 
Road 
Block 
Copyright 2005 Deborah Chisholm, LLC 20 
Impact of Inaccurate Coding of M0670 
Bathing on Reimbursement 
.. “ADLs Are Our Specialty” Home Care 
.. Agency treats large number of patients who live 
alone, have chronic conditions & a surgical 
wound 
.. Case Mix report reveals their current mean for 
Bathing at SOC/ROC is 0.98 which is statistically 
significantly lower than the national reference 
.. Unknown factor affecting accuracy 
.. Few at agency understood how to code M0670 
Bathing accurately 
Copyright 2005 Deborah Chisholm, LLC 21 
M0670 - Bathing 
(M0670) Bathing: Ability to wash entire body. Excludes grooming (washing face 
and hands only). 
0 - Able to bathe self in shower or tub independently. 
1 - With the use of devices, is able to bathe self in shower or tub independently. 
2 - Able to bathe in shower or tub with the assistance of another person: 
(a) for intermittent supervision or encouragement or reminders, OR 
(b) to get in and out of the shower or tub, OR (CMS Q&A 6/2005) 
(c) for washing difficult to reach areas. 
3 - Participates in bathing self in shower or tub, but requires presence of 
another person throughout the bath for assistance or supervision. 
4 - Unable to use the shower or tub and is bathed in bed or bedside chair. 
5 - Unable to effectively participate in bathing and is totally bathed by 
another person. 
UK - Unknown

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Impact of Inaccurate Coding of M0670 
Bathing on Reimbursement 
.. Patient bathes at sink as a result of 
.. Medical restriction post operatively (Ch. 8, pg. 8.92) 
.. A realistic fear of falling (OWBT, M0670 FAQ) 
.. Non-functioning or unsafe bath tub/shower 
(OWBT, M0670 FAQ) 
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Impact of Inaccurate Coding of M0670 
Bathing on Reimbursement 
.. Clinician inaccurately scores according to ability 
to bath in tub/shower 
.. Isn’t aware of CMS guidance 
.. Selects more independent score reflecting patient 
ability 
.. Correct score of 4 or 5 would have added 8 
points to Functional Status domain 
Copyright 2005 Deborah Chisholm, LLC 24 
Impact of Inaccurate Coding of M0670 
Bathing on Reimbursement 
Functional Status Domain 
OASIS Item Description Value Scoring 
M0650 (current) Dressing If M0650 = box 1, 2 or 3 Min = 0-2 
M0660 (current) or Low = 3-15 
M0660 = box 1, 2 or 3 Mod = 16-23 
add 4 to score 
M0670 (current) Bathing If box 2, 3, 4 or 5 add 8 to score 
M0680 (current) Toileting If box 2 - 4, add 3 to score 
M0690 (current) Transferring If box 1, add 3 to score 
High = 24-29 
Max = 30 
If box 2 - 5, add 6 to score 
M0700 (current) Locomotion If box 1 or 2, add 6 to score 
If box 3 - 5, add 9 to score 
.. Bathing is second post powerful Functional Status M0 item 
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The Challenge of Data Accuracy 
.. Problems with data 
.. Key data usually corrected 
.. Non-key often ignored 
.. OASIS Correction Policy for HHAs helpful 
.. Available at: 
www.qtso.com/download/hha/HHAcorrectionpolic 
y.pdf 
.. Correction of errors essential to accurate data 
.. Lack of knowledge

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Improving OASIS Accuracy 
.. Team approach 
.. Data quality audits 
.. Education 
.. Peer Review 
.. Rewards & Recognition 
.. COS-C exam 
.. Accessing and utilizing 
CMS resources 
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Data Quality Audits 
.. Components of quality assurance program 
.. Chapter 12 OASIS Implementation Manual 
Model 
.. Monthly 
.. Clinical Record Audits 
.. Data Entry Audit 
.. Quarterly 
.. Clinical Audit Visits 
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Clinical Record Audits 
.. Monitors the accuracy of OASIS data 
.. Identifies discrepancies between the OASIS 
data & other patient status information in the 
clinical record 
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Management of Discrepancies 
.. Discrepancies between OASIS data and 
clinical documentation inevitable with 
accurate coding 
.. OASIS data set has limitations 
.. Example: There is no healed response for 
pressure ulcer status, so a healed Stage 3 is 
scored as a fully granulating Stage 3

Copyright 2005 Deborah Chisholm, LLC 30 
Management of Discrepancies 
.. Requires explanatory documentation 
.. RFA 1 when no further visits planned 
.. M0250 Response 1 Intravenous or infusion 
therapy selected when the patient does not 
have an IV but will as a result of the 
assessment (CMS Q&A 6/2005) 
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Management of Discrepancies 
.. Requires supporting documentation 
.. M0510 UTI 
.. M0800 Management of Injectable Medications 
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Clinical Record Audits 
.. Clinical record audit 
.. At least 5 SOC & 5 DC from agency (not Transfer to 
Inpatient) assessments 
.. Randomized selection process 
.. Cross-section of patients and providers 
.. Compare OASIS items to other documentation from 
the SOC or DC visits and from other visits surrounding 
the SOC or DC 
.. Performed by QI coordinator & clerical staff 
.. Track and share results 
.. Correct errors submitted to the state 
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Data Entry Audits 
.. Identifies inaccuracies caused by data entry errors 
.. Monthly, select 5 MC/MA records 
.. Randomization not necessary 
.. Compare printout of OASIS data entered into the 
system with source data 
.. Identify discrepancies 
.. If found, correct and resubmit to State 
.. Track and share results

Copyright 2005 Deborah Chisholm, LLC 34 
Quarterly Clinical Audit Visits 
.. Each quarter a supervisory visit should be made with ¼ of 
OASIS assessors 
.. Each clinician will be evaluated once a year 
.. Combine with supervisory visit to be most efficient 
.. Clinician performs admission assessment with supervisor 
observing 
.. Each complete the OASIS independently of one another 
.. Results compared for discrepancies 
.. Discrepancies discussed and education provided when 
appropriate 
.. If OASIS encoded and submitted, correct errors 
.. Track and share results 
Copyright 2005 Deborah Chisholm, LLC 35 
Stumbling Block: Not Knowing 
What You Don’t Know 
.. Everyone must know how to accurately code 
OASIS 
.. MUST begin with Quality manager & educator 
.. Let’s take a Quick Quiz 
Copyright 2005 Deborah Chisholm, LLC 36 
Name the Correct RFA 
.. A home care patient develops chest pain, is 
transported to the hospital emergency room 
and dies of a massive MI, within minutes of 
arrival. 
Copyright 2005 Deborah Chisholm, LLC 37 
Name the Correct RFA 
.. A home care patient develops chest pain, is 
transported to the hospital emergency room 
and dies of a massive MI, within minutes of 
arrival. 
.. RFA 7, Transfer to an Inpatient Facility 
.. Source: CMS OASIS Q&A 6/2005

Copyright 2005 Deborah Chisholm, LLC 38 
Select the Correct Response 
.. Your home care patient takes five 
medications. She is independent with all 
medications except her daily Prednisone. She 
gets confused by the tapering doses. What 
response would you pick for M0780, 
Management of Oral Medications? 
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Select the Correct Response 
.. Your home care patient takes five 
medications. She is independent with all 
medications except her daily Prednisone. She 
gets confused by the tapering doses. What 
response would you pick for M0780, 
Management of Oral Medications? 
.. Response 0, Able to independently take the 
correct oral medications and proper dosages 
at the correct times. 
.. Source: Ch. 8, pg. 8.103 and CMS 6/2005 
Q&A 
Copyright 2005 Deborah Chisholm, LLC 40 
Select the Correct Response 
.. You admitted a patient with COPD to your 
agency. At SOC, she developed SOB while 
dressing or using the commode. At 
discharge, she becomes SOB only when she 
uses the vacuum cleaner. What would be the 
correct response for M0490, “When is the 
patient dyspneic or noticeably Short of 
Breath”? 
Copyright 2005 Deborah Chisholm, LLC 41 
Select the Correct Response 
.. You admitted a patient with COPD to your 
agency. At SOC, she developed SOB while 
dressing or using the commode. At 
discharge, she becomes SOB only when she 
uses the vacuum cleaner. What would be the 
correct response for M0490, “When is the 
patient dyspneic or noticeably Short of 
Breath”? 
.. Answer: Very possibly 0, Never, patient is not 
short of breath 
.. Source: OWBT Special Alert M0490

Copyright 2005 Deborah Chisholm, LLC 42 
So What Do I Do About 
Not Knowing What I Don’t 
Know? 
Copyright 2005 Deborah Chisholm, LLC 43 
Education 
.. Improve reliability 
.. Minimize external sources of variation 
.. Standardize conditions under which measurement 
occurs 
.. Initial and ongoing training sessions 
.. Streamlined and targeted 
.. Most problematic and highly utilized items 
.. OASIS questions proven valid and reliable 
.. Only variable is the source 
.. Field assessors 
.. Data entry staff 
.. Vendor transmitter 
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Education 
.. Item-specific – at hire and ongoing 
.. Corrections 
.. All staff must realize importance 
.. Follow agency policy 
.. No policy, develop one 
.. Must stay current with Q&As and additional 
guidance 
.. www.qtso.com/hhadownload.html 
.. www.oasiscertificate.org 
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Peer Review 
.. All staff involved in quality review 
.. Staff required to perform x number of reviews 
each month/quarter 
.. Review work “counts” as visit 
.. Develop a gold standard chart & review first 
.. Competency staff in chart review 
.. Benefits 
.. Educational tool for weaker staff 
.. Motivational for stronger staff 
.. Assists Quality staff 

Copyright 2005 Deborah Chisholm, LLC 46 
Rewards & Recognition 
.. Positive feedback 
.. Internal staff 
.. System wide 
.. Marketing tool 
.. Methods 
.. Celebrations 
.. Newsletter, newspaper articles 
.. Rewards 
.. Small prizes 
.. Monetary Incentives – “Pay for Quality” 
Copyright 2005 Deborah Chisholm, LLC 47 
Demonstrating Commitment to 
OASIS Accuracy 
.. OASIS Certificate and Competency Board 
.. COS-C examination 
.. www.oasiscertificate.org 
Copyright 2005 Deborah Chisholm, LLC 48 
Helpful Resources 
OASIS 
Implementation 
Manual 
Chapter 12 
Data Quality 
Audits 
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Helpful Resources 
.. OASIS Web-based Training 
.. www.oasistraining.org

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Helpful Resources 
Advanced Scenarios 
OASIS Web-based Training 
Version 2.0 
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Helpful Resources 
OASIS Game from 
The OASIS Web-based 
Training 
Version 2.0 
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Helpful Resources 
Staff Development 
Guide 
OASIS Quiz 
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Helpful Resources 
.. OASIS Web-Based Training Test

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Locating the New Resources 
.. Go to “Reference”, then “Important Resources” 
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CMS Resources 
.. OASIS evolving and maturing 
.. Many different resources available 
.. Rely on CMS-sourced resources 
.. Standardized data requires common 
knowledge and consistent application of rules 
and guidance 
Copyright 2005 Deborah Chisholm, LLC 56 
Overcoming Roadblocks 
.. Improved patient outcomes 
.. Sustained over time 
.. Is it a moving target? 
.. OBQI initiatives nationwide raise the bar 
.. Changes in publicly reported measures 
.. Next month 
.. www.qualityforum.org/archive.htm 
.. Accuracy essential 
Copyright 2005 Deborah Chisholm, LLC 57 
Don’t Let Inaccurate Data Get in 
your Way…

Copyright 2005 Deborah Chisholm, LLC 58 
Of Becoming a Quality Winner! 
Copyright 2005 Deborah Chisholm, LLC 59 
References 
.. OASIS Implementation Manual 
.. www.cms.hhs.gov/oasis/usermanu.asp 
.. OBQI Implementation Manual 
.. www.cms.hhs.gov/oasis/obqi.asp 
.. Data Quality: The Accuracy Dimension 
.. Olsen, JE, December 2002, Morgan Kaufmann 
.. How OASIS data quality affects you! 
.. RG Irwin, Home Healthcare Nurse, Sept. 1999 
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References 
.. CMS Q&As 6/2005 
.. www.qtso.com/hhadownload.html 
.. OCCB CMS Q&As 
.. www.oasiscertificate.org 
.. CMS OASIS Web-based Training, FAQs & 
Item Specific Guidance 
.. www.oasistraining.org 
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References 
.. Accuracy in the Outcomes and Assessment 
Information Set (OASIS): results of a video 
simulation 
.. Madigan EA, Tullai-McGuiness S, Fortinsky RH. 
Research in Nursing & Health, August 2003 
.. Quality Improvement in Home Care, Joint 
Commission on Accreditation of Health Care 
Organizations, 1993