Different spin on previous post on documentation tampering

[Capco56]

I recently started work at a new HH agency with a reputable name after about 1-1/2 years at another agency. I do a lot of SOC's and am feeling pressured by the QA manager to "re-evaluate" my answers to those high reimbursement OASIS questions. Although no one actually changes my answers as was mentioned in a previous post, I do feel like I have to "skew" them to reflect a worse scenario than what I actually see or how the patients say they feel. I would be interested to know how many nurses feel this way. I never felt this at the other agency I was at and I understand that we have to show improvement and indicate what the patient can "safely" do, but I just don't feel comfortable changing some of the questions they ask me to re-evaluate. It makes me question my assessment skills even though I feel I do a thorough job. Is this the unfortunate future of home health?

[caliotter3]

It would only be your assessment skills to a certain degree. Once you have enough experience to have developed your assessment skill set, you will be consistent in your findings. Then it becomes a matter of "finding" what the people at the agency want you to "find" so that their criteria can be met. Either you change your reporting behavior to align itself with what they want, or you butt heads.

[Isabelle49]

You QA manager knows what needs to be done to jack-up the HHRG, resulting in higher payment. You assessed the patient, so you know the patient. Don't second guess yourself, but if a patient barely fits one scenario, it is, best to change an answer to the next level, and in doing so you may have a positive outcome if the patient improves. You don't want a negative outcome if it can be avoided.

[cathrn64]

I agree with Isabelle49. However, at the agency I work for, we went through some extensive Oasis C training. I was surprised to find that the QA people were right in some of their requests for re-eval's. I did learn a few things and am somewhat more open to some of their requests now

[KateRN1]

Your assessment skills are likely top-notch but how you interpret the OASIS may be another story. Most clinicians just don't understand the intent of the OASIS items and are taking the questions at face value without understanding what the questions and answers really mean. I am one of those QI managers who is constantly asking people to reevaluate their OASIS scoring because it just doesn't match up. For example, an RN recently marked (2) able to walk wafely with a two-handed device for a patient who she believed would be safe with a walker. The patient did not have a walker and the RN did not see her use a walker, but assumed that her ambulation deficits would be resolved with a walker. However, we cannot assume safety with a piece of equipment that we are not able to directly assess, so the correct response would be (3) the patient requires the assitance of another person to ambulate safely. We went round and round over this and I know that she did not really understand why her answer was inappropriate. Same thing with medications. A patient must be able to take 100% of their medications 100% correctly 100% of the time with 100% of the knowledge required to be independent with their medications. If the patient needs even minimum education on meds, they cannot be scored as independent with medication administration. The OASIS should clearly show the deficits of a patient and if the patient "doesn't quite" meet the criteria for a higher level score, then you MUST drop down to the lower score, even if you don't think the patient is "that sick." If you score your patient as indepdendent with ADLs but insist s/he needs therapy, why do they need therapy? Where is the functional deficit? Rather than trying to justify why your answers are correct, try to wrap your brain around what Medicare really wants the OASIS to reflect--the patient's cognitive and functional deficits that justify the need for home care. Ask your agency to invest in an OASIS training program for the clinicians who complete OASIS assessments. There are many programs out there--from software based to web based to seminars. Check with your state's home care association or with the OASIS Answers group and look into becoming OASIS certified.

[annaedRN, RN]

Kate- well said as usual. It's what I was thinking but you said it ever so much better than I could have. Use the guidance (manual) for OASIS to answer your OASIS questions, use the head to toe assessment to document your findings. Always think SAFETY!! And like Kate said - do not assume safety. Our agency has recently started giving out OASIS "M" question handouts one "M" at a time - the "M" question, with the most important guidance listed, and tips/tricks to think about accurately answering questions and maybe an example. Giving clinicians time to look at one question at a time lets them think about it a little more - rather than a long inservice. Has people asking questions atleast.