CMS OASIS: Ace the Supply Management Requirements


Your home health agency is almost certainly still adjusting to the significantly new PPS system. Among the many changes came the un-bundling of non-routine medical supplies (NRS) -- a big deal to the home care industry, which has conventionally not paid enough attention to the procurement, utilization and billing of supplies since CMS initiated PPS. However that’s essentially as the original PPS model bundled supplies into the patient HHRG. The question is: Can you really take care of stage 4 wounds with the dollar amount that we've been allocated. But it didn’t seem real likely to me. Let us see how CMS OASIS would look like with two stage 4 pressure ulcers.

Suppose at MO450, two or more pressure ulcers are stage 3 or 4. The patient has two stage 4 ulcers and received three points there at MO450 and then at MO460, the most problematic ulcer was a stage 4 so they scored a 4 on their OASIS and got 16 points there.

So what did that do? The functional points you can scroll through just remained at six. And go to slide 48. We have a C3 F2 F2 $2,855.38. We had a total of $67 supply points and remember, those non-routine supply points come from table 10B of the CMS table. And they're additive according to the recent CMS OASIS rules. You're adding the MO450 score to get the total points. This patient ended up being a non-routine supply severity level five. And the total add-on is $320.37, for total revenue of $3,175.75. So let's see what happens with best practice.

Let us see what has happened across the board here. You can compare the unstaged wound, you can compare the stage 2 pressure ulcer against the stage 3 and then two stage 4s.  Let’s take a look at best practice management of these two stage 4 pressure ulcers.

Suppose the total cost was $207.96. So yes, they were able to come in under the total dollar amount of $320 and some cents. Well then, the wound care nurses decided they wanted to make it even more complicated because they didn’t believed it either. And they said, “Well, what if your stage 4 wounds were infected.”

So now we have a description of stage 4 infected wounds.  Suppose the supplies and the total dollars were $310.32. So, they did come in under the total dollar amount.

Now again, there are going to be situations where you are not going to come in under that level, situations that you're unable to change the physician’s orders about, you know, how he or she wants that wound taken care of as per the home health guidelines.

Home Health Training Tip: But the importance of this really, is to just demonstrate that it is possible and it's very, very important that you are very actively looking at this and working hard to have as many situations as possible where you have wound care experts and other industry as experts sitting down to help you develop best practices. So that you can look at how much you're spending and what your patient outcomes really are.

There's also another home health compare element added into the items and for the demonstration project as far as pay for performance on problematic wounds and hospitalizations related to wound issues. So this is a very, very important thing to know about.

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