Editorial


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Editorial 
 

COST IMPACT OF MEDICARE OASIS OUTCOME 
MEASUREMENT FOR RURAL HOME HEALTH AGENCIES 

 
Melondie Carter 

Editorial Board Member 
 
 

Many home health agencies (HHA) are in small towns located in rural areas. Due to 
volume restraints, a rural home health agency desiring to excel financially must endeavor to 
understand OASIS (the Outcome and Assessment Information Set). Rural HHAs must ensure 
that their OASIS assessments are completed thoroughly, consistently, and accurately. OASIS 
was developed over more than a decade by researchers at the University of Colorado Health 
Sciences Center (see http://www.uchsc.edu/), with funding for Medicare and Medicaid 
Services (CMS) and the Robert Wood Johnson Foundation. The CMS requires that OASIS 
data be reported and this data is used for two purposes: “ to monitor outcomes of home health 
agency services and (as of October 2000) as an indicator of patient severity and needs in 
determining payment amounts under Medicare’s home health prospective payment system” 
(Keepnews, Capitman, and Rosati, pg. 79).  

There are 80 OASIS data points that represent core items of a comprehensive 
assessment of an adult home care patient and are essential for measuring outcomes. These 
data points are detailed and precisely defined to permit comparative results. Eleven of these 
data points are also currently used for public report card ratings of home health agencies for 
consumers. The initial assessment is performed at the start of care visit in the patient’s home. 
Findings from the assessment and answers to the OASIS questions determine points assigned 
to the clinical status, functional status, and service utilization domains.  

Points in the clinical domain are based on the primary and first secondary diagnosis 
that are approved in the orthopedic, neurological, or diabetes category, IV infusions, enteral 
tubes, wounds, dyspnea, urinary and bowel incontinence, bowel ostomy, and behavioral 
problems. Points in the functional status domain are based on dressing upper and lower body, 
bathing, transferring, and locomotion. The service utilization domain includes points the 
patient receives for ten or more therapy visits within a 60-day episode of care. From the start 
of a patient’s care, the agency must lock the OASIS data to the state within seven days. After 
the OASIS is complete, the patient admitted, and the physician’s orders are sent for signature, 
the HHA can submit the request for the anticipated payment document for payment of 60 
percent of the home health resource group (HHRG) rate. In determining HHRG payment, care 
must be taken to ensure accurate reporting. For example, inaccurate assessments can lead to 
minor mistakes in diagnosis coding that can lead to payment loss dollars. Just one level in 
severity code from C0 to C1 leads to a payment difference of approximately $183; S1 to S2 is 
greater than $1,600. Considering the numbers of patients seen, these types of differences in 
reimbursement potential demonstrate the necessity of accurate diagnosis coding. 
 

REFERENCES 
 
Keepnews, D., Capitman, J., & Rosati, R. (2004). Measuring patient-level clinical outcomes 

of home health care. Journal of Nursing Scholarship, 36(1), 79-85. 

 Online Journal of Rural Nursing and Health Care, vol. 4, no. 2, Fall 2004
 

http://www.uchsc.edu/