OASIS-Central

Q: Medicare requires a discharge OASIS on patients who have been stable and reimbursed by Medicaid when they have an exacerbation of their condition and have to be switched to Medicare under a new episode (i.e., if they are at home when this occurs and not in a facility). This means a discharge OASIS is completed at a time when the patients outcomes are their worst. It looks as if we are stopping services when a patient gets worse, when in fact we are increasing their services under a new payer. Over half of our patients are dually eligible for Medicaid and Medicare and this significantly affects our outcomes in a negative way.  Has CMS addressed this at all?

A: Because resources may differ based on the patient’s payer source, separating a change from Medicaid to Medicare (and vice versa) into separate episodes allows outcomes to be analyzed specific to the payer source. Although risk adjustment is intended to help even out the playing field, the goal of outcomes is, ultimately, to improve quality. If an agency has a large number of patients who are declining under the Medicaid program, then the goal is to implement best practices to attempt to mitigate those outcomes. That might involve attempting to assess earlier in the patient’s Medicaid episode when the patient becomes eligible for Medicare services so that greater resources may be implemented to impact outcomes before the patient’s condition declines.