Percent of Patients with Pressure Ulcers That Are New or Worsened: OASIS-C2 Covariate (GG0170C)

Percent of Patients with Pressure Ulcers That Are New or Worsened: OASIS-C2 Covariate (GG0170C)


»» Hi everyone. So we’re all awake and ready for a new item
on OASIS-C2. Welcome. Again, my name is Ann Olson. I was very grateful for Mark’s nice introduction. I am the other Ann with Qualidigm. There’s actually three vice presidents that
are named Ann in Qualidigm, just an important fact that I figured you all wanted to know. But I’m thrilled to be here to talk to you
about the new item GG0170C. As you’ve heard today, this is a new measure
that is a covariate. And that’s a popular term today that does
impact the quality measure for percent of patients that have pressure ulcers that are
new or worsened. So what we’re going to be talking about today
is really demonstrating a working knowledge of this new item. I’m sure you’ve all heard about it. What is it? GG0170C, mobility. This is talking about moving from lying to
sitting on the side of the bed, which is not new for any of us in home care. It’s just a new measure. And we’re going to be talking about really
the intent of the measure, how to interpret the coding options for GG0170C, and then apply
those instructions as Ann ended her presentation. It’s so important that you leave here today
with action steps so that you can instruct your staff. So that is our objective, is that you will
leave with that information following the presentation. We did want to clarify, and you’ve heard Ann
mention several times about code and coding. We just wanted to clarify that in home care
we talk about coders, often about our ICD-10 coders, those very special people that have
that training in ICD-10 coding. We are talking, as I think you all know, about
scoring the OASIS. So the word “code” and “coding” is synonymous
with scoring. So we talked a lot about the quality measure
covariates. Both Nicole Keane and Ann Spenard talked about
covariates, that they are one of the three risk adjustment types. And that they are patient characteristics
that affect a certain outcome for our patients. And the items that you see on the screen here,
Ann Spenard mentioned these, M1028, which is active diagnosis, 1060, height and weight,
and 1620, bowel incontinence. Those are three covariates that my colleague
Kathy Roby will be speaking to later today. And we’re going to be talking about the fourth,
which is the GG0170C, lying to sitting on the side of the bed. So you all know this is a new item. I don’t know if you’ve all found it in the
OASIS. I just thought I’d orient you it’s in the
ADL/IADLs section and found in between M1850, which is transferring, and before M1860, which
is ambulation and locomotion. And the item intent, so we read specifically
what GG0170C says, which is, it identifies the patient’s need for assistance with the
mobility task of moving from lying on the back, to sitting on the side of the bed with
feet flat on the floor, with no back support. So that’s a real formal way of saying what
we do every day in home care. We go in and we always want to assess how
is the patient at moving from a lying position to sitting on the side of the bed and safely
sitting with their feet on the floor. That’s something that we’ve been assessing
for years now. But what’s important, that this is a new measure
that’s going to help us to quantify this and one of the IMPACT Act measures that we’ve
all talked about. So that we’re going to have a consistent way
of identifying the patient’s ability to perform this task and whether they can do it by themselves,
or whether they need assistance in doing that. By using this measure, and again this is across
all settings as the other speakers have talked about, we’re going to have the uniformity
of this data. It will have that interoperability that’s
so important. And also, this whole covariate piece, so that
it’s really looking at how does the patient’s mobility impact the risk for pressure ulcers
that Ann Spenard spoke to earlier. So the rationale I think has been talked about
and we’ve all heard about in nursing school for many years. And in our experience that it’s no news that
immobility can lead to a higher risk for pressure ulcer. It can adversely affect wound healing. And it also can increase your risk for development
of pressure ulcers. So obviously, that’s one of the main reasons
why we’re looking at GG0170C. And what time points is this? I’m sorry. I didn’t push the button. Sorry. What time points are we completing this? We’re doing this at the start of care, which
as we all know is within five days of the start of care date. And we’re doing this at the resumption of
care, which is within 48 hours of a return to home after an inpatient facility discharge. So how do we complete this? How do we obtain this information? What are the steps for the assessment for
GG0170C? The first, obviously is to observe and assess
the patient’s ability to do this. This is our greatest skill, one of our greatest
skills in home health. So have the patient perform the task. We also want to get as full a picture as possible. So obviously, ask the family members or the
caregivers how does the patient perform this task? So you’re pulling all of the information together
to assess what their ability is to move from lying to sitting on the side of the bed. Again, the patient should be allowed to do
this independently, as much as they can, as long as it’s safe. And that’s always a key factor for us in any
care setting is that we want to ensure that the patient is safe performing any of the
activities that we’re asking them to do. But if caregiver assistance is required because
it’s unsafe for them to do it themselves, we’re going to be responding and scoring GG0170C
based on how much assistance do they require? And we’ll be going through the scoring as
to how you would do that. Another important piece that we need to make
note of is the use of an assistive device and the fact that with GG0170C, the patient
can use an assistive device. And that does not change the scoring at all
for this measure. So if a patient needs to push off their bedside
table, that could be considered an assistive device. That would not impact the scoring. If they can do that independently, you would
still score them as independent. I also, with a colleague, she received home
physical therapy. Her physical therapist in home care instructed
her to use a belt to move her legs from lying to the side of the bed. That would still be considered independent. She was able to perform that activity. The assistive device of a belt or a strap,
or whatever it is that the patient needs to use to move safely, independently from lying
to sitting is still considered acceptable and does not impact the scoring. So they would still be considered independent
in that activity. And the last step that we want to highlight
for you is that the patient’s performance many times can vary. So what we’re looking for in the guidance
from CMS is that we’re looking at the patient’s usual status. So we wouldn’t be taking their best performance,
or maybe that one time that they really couldn’t get out of that lying position because maybe
they had a bad night’s sleep. You want to take the patient’s usual performance
as the scoring for this measure. So this is a screenshot of how the measure
does appear on the OASIS. You can see on the top, it does give you the
coding instructions for both the start of care performance, the SOC/ROC Performance
scoring. And then also looking at coding the patient’s
Discharge Goal, and which coding items you can use for that. On the left, you’ll see the coding options
that you have. And we’ll be going into each of those in a
few minutes. And the highlighted area, number one, so this
is GG0170C1 which is the yellow column that you see, that will be the score that you give
for the SOC/ROC Performance. The second column is the Discharge Goal. And you’ll be determining that at the same
time. But again, you’re going to be using the patient’s
input, your assessment, and the caregiver’s to score the patient’s Discharge Goal. And again we’ll be getting
into that. But the measure, and again this is on the
far right side, looking at the definition of what we’re actually trying to score here. It’s the patient’s ability to safely move
from lying on their back to sitting on the side of the bed with their feet flat on the
floor and no back support. So that’s really not rocket science if you
try to break it down. And we just need to score them as to how well
they can do that on their own, or how much assistance that they need to perform that
activity. So the coding instructions, we do have a 6-point
scale that is pretty self explanatory. We’re going to go through each of those. Code 06 is if the patient can perform this
activity independently. Code 05 would be if they require setup or
clean-up assistance. Code 04 would be supervision or touching assistance. Code 03 for partial or moderate assistance. Code 02 is for substantial or maximal assistance. And then Code 01 would be for a dependent
— excuse me, for a dependent patient would be Code 01. And we do have options for if the patient
— we do not attempt this activity for a variety of reasons, or if the caregiver that is there
to help the patient, we did not attempt the activity. Those would be Code 07, which is when a patient
would refuse to do this. Code 09 would be used if it’s not applicable. And again we’ll get into the details of that. And Code 88 would be used if it was not attempted
because of a medical condition or safety concerns. So looking at the actual screenshot of the
measure, you can see the highlighted area which is the Code 06 for independent. And this is, as I described earlier, if the
patient can complete the activity by him or herself without any human assistance whatsoever. So there would be no caregiver helping in
any way. The patient wakes up, and their alarm goes
off. And they’re able to get up from lying to sitting
on the side of the bed and get their feet on the floor without any assistance. That would be a Code 06, independent. Code 05 is used for a setup or clean-up assistance. And that’s a fancy way of talking about a
patient that really can do it pretty much independently, but prior to doing the activity,
or immediately after the activity, they might need some setup assistance. So an example of this would be a patient that
requires a sling on their shoulder to get up and they need a caregiver to help put that
sling on. So once the caregiver goes over and places
that sling on the patient, the patient’s able to get up and swing their legs over and put
their feet down. So that would be a score 05. Another example would be a patient that is
unable to put the bedding, put their covers down at the bottom of the bed. They can’t get their feet untangled from their
covers. So the caregiver would have to pull down the
covers and then the patient would be able to move their legs to the side of the bed
safely. Another example, which was one of the questions
that had come up on the CMS site was for a patient that can’t reach the floor. My mom is like 4 foot 10 and she can’t reach
the floor when she sits up. She’s so cute, little Italian lady. We love her. (Laughter) And we would need the put a little
stool on the floor for her just so she could get her feet, especially when she comes to
visit me, because my bed is higher than her bed at home. But that would be a setup so that she could
do the activity safely. Again, it’s not doing it for the patient. You’re not assisting them, other than to give
them assistance for setup and then maybe remove that stool. So that would be the cleanup. And you would score that patient as a 05,
just needing that little bit of assistance prior to or after the activity. Code 04 is used — and again, we’re going
up in terms of assistance. This would be used when the patient needs
some supervision or touching assistance. And I know you’re all picturing the little
old lady in your head that you’ve seen, right, that is just laying in bed and needs maybe
a little coaxing, a little encouragement, you know “you can do this.” Maybe putting your hand on their shoulder
to just guide them, but really not physically helping them move from lying to sitting, but
just coaxing them, giving them some supervision, some encouragement. This would be a Code 04 . So again, it’s assistance
that could be provided throughout the activity, or it could be provided just intermittently,
or just at the beginning of the activity to just coax them and encourage them to move
and get from lying to sitting on the side of the bed. So again, it’s an encouragement and supervision
so that the patient will perform the activity, and that you’re making sure that they’re safe
to do that. Code 03 is used for partial or moderate assistance. And the keywords here, and you’re going to
be hearing this for the next coding is the “amount of effort.” So for Code 03, the partial or moderate assistance,
we’re really looking at a patient that really does more than half the effort. So the caregiver is providing less than half
of the effort. So the caregiver could be lifting their trunk,
helping them move up to a sitting position. They could be lifting the legs a little bit
to help them slide them over so that they can put them, their feet on the floor. But it’s less than half the effort. The patient’s doing more than half. So again, that’s a clinical judgment. But seeing whether it’s less than half or
more than half is the distinction between Code 03 and Code 02. So I’ve answered for Code 02, which is when
the caregiver does provide more than half of the effort to move from sitting or lying
to sitting on the side of bed. Again, the patient would be providing less
than half, so that the caregiver’s really doing more of the work than the patient is. And this is done again throughout the activity,
both Code 03 and Code 02 are support assistance that the caregiver is providing throughout
the entire activity. This is compared to when they were providing
just some cuing assistance or contact-guard assistance. That could be intermittent. And the code that we talked about whether
you would do setup, that was really prior to and after. So Code 03 and 02 are, they need assistance
throughout that whole movement to get from lying to sitting on the side of the bed. And the last numeric code is Code 01. And that is for a dependent patient. This would be the patients that we know that
can’t perform this activity at all. They would need 100% assistance. It would be by one caregiver, or it could
be two or three caregivers that are required to get the patient from a lying to sitting
position with their feet on the floor. Again, this would obviously be someone that
gets this assistance throughout the activity. So the caregiver or the family member would
be, you know, really providing all of that assistance, doing all the effort for the patient
so that they could complete this. So now we’re moving on to the coding options,
if the activity was not attempted and why that would be justified and an appropriate
code or score to use. So Code 07 is when a patient refuses to complete
the activity. I’m sure all of you have patients that participate
and cooperate 100% of the time, right? (Laughter) That would be a wonderful world
that we’d live in. But we don’t. And it’s home care, and we know that we have
all sorts of wonderful challenges. Actually we have that in all of our care settings. Pretty self explanatory. If the patient refuses to do this activity,
and we know that we’ve had those, that patient would be scored a 07, that they just refused
to perform the activity. So Code 09 would be, not applicable. And this is really for a patient that would
not have been able to perform this activity prior to the reason why we’re providing home
care for them. So this would be your patient that would never
have been able to do this before, they maybe had their knee replacement or whatever reason
you’re in providing home care services for them. So it wouldn’t be applicable that we’re in
providing a new episode of care to expect that they would be able to do this, because
they couldn’t do it before. So that would be a code of 09. And it would be not applicable. And Code 88 would be if the activity was not
attempted. This would be due to a medical condition or
a safety concern that would prevent the clinician from performing this activity. So this would be an appropriate code to use
if their medical condition really prohibited the patient from performing that activity. And the last coding option is the dash, which
Ann Spenard had talked about earlier. The dash is a valid response for GG0170C1
which is the SOC/ROC Performance coding. It is a very rare occurrence that you would
use the dash. And CMS would expect that you really are not
using this as a frequent response. It would really most often occur if the patient
was unexpectedly transferred, or discharged, or died prior to the assessment item being
completed. So in that instance, it would be appropriate
to use the dash. So some of the key coding questions that you
can use to help your clinician’s, your nurses decide how are they going to answer these
questions, a good way to approach it would be, well, what questions could you ask yourself
to help guide you in answering GG0170C accurately? So the first question is, does the patient
need assistance? That would be the first line. And obviously, if you said, no, the patient
doesn’t require any assistance at all, then this scoring would be 06, because they’re
independent. If the clinician asked themselves, well does
the patient need just a setup or clean-up? Do they need that stool, or do they need some
type of assistive device to help them move from lying to sitting? That would be the — the belt would be a 06,
that would be independent. But if the patient needed setup, they need
clean-up, they need the nurse or the caregiver to help put a stool down as we described earlier,
then the answer would be, yes. It would be a Code 05. What if the nurse could ask themselves, do
they just need some verbal cueing? Do they need some encouragement? Are they just, you know, really feeling unmotivated
to perform this activity, or nervous? We have a lot of our patients that, you know,
it might not be physically that they can’t do this, but they just really need to have
their anxiety reduced a little bit. So if you’re there and you can coax them,
you can help them put your arm on their shoulder, as I mentioned. If the nurse says to themselves, well, does
the patient just need that verbal cueing and that assistance? Then I’m going to score them a 04 for supervision
and touching assistance. Or these key questions about this, more than
half the effort or less than half the effort, this is a key area that you’re going to really
need to talk with your nurses about and help them to really internalize this way of gauging
whether it would be a score for 03, or 02. For 03, again we talked about, is it less
than half the effort? If it’s less than half, so the patient is
doing more of the effort, then the nurse would say, yes. It’s a Code 03. And in contrast to that would be Code 02. So does the patient need the caregiver to
do more than half of the effort? So again, this is the distinguishing factor
between 03 and 02. And the nurses are really going to need to
ask themselves this so that they can arrive at the proper code, whether it was more than
half the effort. And when it’s more than half, it would be
a code of 02, which is indicating that it’s substantial or maximal assistance versus the
Code 03, which was the minimal assistance. And then the last question or coding question
that the nurses should be thinking to themselves is, does the helper provide all of the effort? And I think many times these dependent patients,
that we really have to provide 100% to help them get from from lying to sitting on the
side of the bed. Those seem to be the clearer scenarios. That would be obviously a dependent coding. That would be a Code 01 for dependent to move
from lying to sitting on the side of the bed with their feet on the floor. Then these last codes, again if the activity
was not attempted. Again you have the Code 07, which is if the
patient refused. You have Code 09, which was the not applicable
code. So if the patient did not perform the activity
prior to this current illness, you would be coding them a 09. Or Code 88, which would be that you did not
attempt the activity due to a medical condition or a safety concern. So we do have some coding tips. And some of these were actually created because
we’ve been very happy to receive questions from our home health colleagues throughout
the country. One of the questions, which we thought was
a really great question, and I know you’ll all be able to relate to is, what if the patient
doesn’t sleep on a traditional bed? And I know we all have those patients that
like to sleep in a recliner. I know my dad was guilty of that very often. These are patients that just don’t like to
sleep in a traditional bed for whatever reason. It might be a medical condition or it just
might be a preference. How do we score someone that does not sleep
in a traditional bed when we’re trying to measure lying and moving to sitting on the
side of the bed? So we did obtain guidance from CMS on this
question. And you basically would be scoring the patient
as they are able to perform the activity in this alternate sleep surface. So if they sleep in a recliner, you would
be assessing their ability to move from the reclining position, which would be lying for
the patient, and how they’re able to get up and swing their legs over, get their feet
on the floor. And you would code them based on that. Again the assistance that they need to move
from that other surface, I actually in home health, we had a patient that slept on the
floor on a mattress. They were safe. It was their preference. Once we got over that, and I don’t know if
any of you have had patients that slept on a mattress on the floor, but this was because
of a back issue. And they were most comfortable. But they were able to get their legs down,
their feet on the floor, and get right up from that sleep surface. That would be independent. So again, there will take a little bit of
judgment on this. But if that is their sleeping surface, that’s
what they consider their bed, you would assess the measure with the same guidance that we’ve
talked about with the actual traditional bed. So I hope that that’s clear. And we can talk about any questions if you
have questions on that. So what if the patient’s feet don’t touch
the floor? I mentioned that in the example for the setup
example for the Code 05, when you put a stool under the patient. But what if the patient, gets up, they’re
able to get from lying. They’re able to swing their legs over by themselves. And they’re able to sit very safely with their
feet just hanging without them on the floor. Is that a independent score for 06? It would be. Because the patient’s able to do that safely. And again, in home care, in all of our care
settings, we just need to remember that the safety aspect of things, the patient’s able
to do that. They’re safe sitting on the side of the bed. They don’t need any support on their back. Even though their feet don’t touch the floor
initially, and they scooch a little bit to get their feet to the floor, that would still
be independent. And you would score that a 06. For the patient with the step stool that I
mentioned previously, again the assessing clinician feels that the patient is not safe
sitting at the bedside without their feet on the floor. I know we’ve all seen those patients, right. They sit up, and they try to swing their legs
and then they’re ready to fall back down. So a patient that’s able to get their feet
close to the floor, but they can’t reach the floor and they’re unsteady, and they’re going
to fall back. So by using a foot stool, you would be able
to make this activity safe for them. You would be able to score them a 05. You wouldn’t have to be supporting them. They’re able to get up, get their feet down. And If you put a stool under their feet it
would be safe for them. So it would be the scoring of a 05 for setup
and clean-up assistance. So again, for last but not least coding tips,
we really need to report the help that the patient needs to complete this lying to sitting
transfer. And if you keep that in your mind and use
that as really the driving message to your clinicians that you’re really trying to just
quantify how much help does the patient require to move from lying to sitting? And again, just keep remembering why we’re
doing this. Because it is a covariate for the pressure
ulcer, worsening pressure ulcer quality measure. A patient that’s not able to perform this
activity, they need assistance. That is something that is a risk. It is a risk adjuster for that quality measure. So it’s important that we get it right. And we’re just evaluating how much help they
really need to complete the activity. We do understand, and I mentioned earlier
as well that clinical judgment is required in everything that we do. I know all of you did a great job on all the
scoring that Ann Spenard did with the pressure ulcers. A lot of clinical judgment that comes into
play with that. And this applies as well for GG0170C, that
you’re going to need to use clinical judgment to make this determination with the usual
status, with the amount of assistance that the patient needs. And that will help you to make the appropriate
determination and the appropriate scoring for this measure. So now we’re moving on to the Discharge Goal,
which is GG0170C2. So the C2 is the second column that you can
see highlighted on the screen now. And so basically for GG0170C2, we’re going
to be scoring what we feel, and what we feel after discussing with the patient and other
conditions that we’ll talk about, how would the patient’s discharge performance look like? We’ll only be using the 0-06 scores. So the 6-point scale is really the only scoring
that would be appropriate for the Discharge Goal. We would not be entering 07, or 09, or 88. The patient’s not going to be refusing because
we’re not asking them to perform the discharge activity. It’s really our determination in conjunction
with the patient and the family to really establish what’s an appropriate goal for this
patient for their end activity to be able to do this at discharge? How would we score them on discharge for this
measure? So some of the coding instructions for this,
and again, I’m sure this is not new measures, new information for you that the clinicians
would really need to be, considering various factors when they’re trying to code GG0170C2
for the Discharge Goal. You’d need to really consider the patient’s
medical condition or conditions. So is that going to impact how well they’re
going to progress at discharge in getting from this lying position to sitting on the
side of the bed? How about the expected treatments that we
have? What are our orders? What are we providing in home care? And do we feel that the treatments that we’ll
be providing is going to get the patient to a better place or possibly not? So that’s part of how we’re going to be considering
what the appropriate Discharge Goal score would be. What is the patient’s motivation to improve? We talked about the patient that refused to
do the activity. We have all varieties of patients in terms
of their motivation. So we need to take into consideration in talking
with them and observing what their motivation is to improve from where they are today at
the SOC/ROC Performance and where do we feel, based on all of these factors, will they be
at the time of discharge? We also are looking at what their prior self-care
and mobility status is. Obviously that’s a key issue as to how much
better, how much improvement can we expect based on what their prior level of function
was. So that will obviously be something that’s
going to impact the Discharge Goal. And then looking at whether there are current
multiple diagnoses that could be impacting scoring as well. So again, we can’t stress enough that the
importance of getting an accurate goal is looking at all of those factors, but also
having a very frank discussion with the patient and the family, the caregivers, to really
determine what is the appropriate Discharge Goal for this patient when you’re there at
the SOC/ROC, at that start of care or the resumption of care? Where do you expect that patient to be at
the time of discharge for this measure? So the use of the dash for the GG0170C2 is
an appropriate or a valid response. Again we have to stress that it would be something
that would be rarely used. It’s valid if the patient unexpectedly is
transferred or discharged so that you’re not able to complete this assessment at that time. So you would be able to use the dash. But again, it would be a rare time that you
would use dash as the code for the Discharge Goal. So what would be the scenario that your nurses
would determine that the Discharge Goal is higher than the SOC/ROC Performance? We’d like to think that all of our patients
improve. Sometimes there are reasons why the score
would not be better. But in the instance where the Discharge Goal
is higher, it would be that the clinician has determined with the patient and the family
that the patient should be expected to make functional progress by discharge, and that
the response reported for the Discharge Goal will be higher or more independent than the
SOC/ROC Performance response. So if your initial SOC/ROC Performance was
03, and you felt that the patient would be independent at discharge, that would be an
instance where you would have an improved or higher score on the Discharge Goal versus
the start of care performance code. The Discharge Goal code being the same, there
are instances that when your nurses, the clinician talks with the patient and the family, they
determine that due to the medical complexity of the patient, that they are not expected
to make progress during the home health episode. That it’s expected that they’re going to maintain
that level of function, but because of the medical complexity of their condition, it’s
determined that the patient’s score at the start of care or the resumption of care for
this activity is not going to improve, but it’s not going to get worse either. So in that instance, the Discharge Goal would
be the same as the SOC/ROC Performance code. And there are some instances that unfortunately
a patient’s Discharge Goal would be lower than the SOC/ROC Performance code. This would be when the caregiver and the family,
other members determine that the patient has a progressive neurological dysfunction, a
condition that would be expecting that the patient would be rapidly declining because
of that condition. In that instance, we would be providing skilled
therapy services, skilled nursing services possibly to slow that decline. But when you’re considering all of the factors
and trying to score GG0170C2 as a Discharge Goal, you would not say that the patient’s
going to be improved or stay the same. Because of that neurological condition, you
would determine that the patient is going to be at a lower scoring, again moving from
lying to sitting on the side of the bed. So in that instance, it would be a lower score
than the start of care or resumption of care performance. So we are getting to the fun part now. I know you guys love these practice scenarios. I was watching you all with Ann Spenard’s
practice. And you all did a great job. So again, we invite our listeners that are
online to please take out a piece of paper and participate in our practice scenarios. This is really where the rubber hits the road. We can talk about concepts all day, but it’s
really important that we practice this and try to be sure that we can get this right
when we’re teaching our nurses how to score this very important item. So the first practice scenario is about Ms.
A. Ms. A pushes up from the bed to get herself from a lying to a seated position. I think people are looking for a scoring sheet. Is that what you’re looking for? Yeah, I’m sorry. So there is no scoring sheet for this. You can just take notes on a piece of paper. And we’re going to be using the polling question. So there’s not a scoring sheet like Ann Spenard
had. So you’re off the hook. You don’t have to do heavy-duty homework,
just a little bit. So I’ll start again. Ms. A pushes up from the bed to get herself
from a lying to a seated position. The caregiver must provide steadying or touching
as Ms. A scoots herself to the edge of the bed and lowers her feet onto the floor. So how would you code GG0170C1? Wow. That was great. And what would your rationale be? Yep. (audience chatter) Yep. So I heard a couple of answers. There was — again, Ms. A pushes up from
the bed to get herself to a lying and seated position. The caregiver provides touching assistance. I did hear 05, and I heard 04. The actual coding would be 04 because the
caregiver’s providing supervision or touching assistance. So 05 would be just that setup, either before
or after. So this is a tricky one that you want to just
understand the distinction there. So Ms. A required that steadying, the touching
assistance in order to safely complete the task to move from lying on her back to sitting
on the side of the bed. So this next scenario is going to be one of
our polling questions. This is about Mr. B. He pushes up on the bed
to attempt to get himself from a lying to a seated position as the occupational therapist
provides much of the lifting assistance necessary for him to sit upright. The OT provides assistance as Mr. B scoots
himself to the edge of the bed and lowers his feet to the floor. Overall, the OT must provide more than half
of the effort to complete the task. I’m hearing a lot of 02s. Any others? So please, use your polling device on the
table. So again, we have A would be Code 04 for supervision
or touching. Code 03 for partial or moderate assistance. Code 02 would be for substantial or maximal
assistance. And Code 01 was for dependent. And we see the majority of people chose, C,
which was 02 for the substantial or maximal assistance. And that is correct. So Code 02, the way the scenario described
Mr. B required the caregiver to provide lifting and assistance that represented more than
half of the effort. And again that was the distinction that we
talked about. So when I look at the scores, it was really
divided between coding for 03, which is less than half, or choosing Code 02, which is more
than half. So this is a clinical decision and determination
that the nurse would apply as they’re watching and observing the patient, and how much assistance
did they require? In this case Mr. B again required assistance
that was more than half the effort to complete the task. So that would be scored as a 02. So the next practice scenario is Mrs. Y. Mrs. Y is obese and will be recovering from
surgery for spinal stenosis with lower extremity weakness — oh. I’m sorry. Thank you. So Mrs. Y is obese and recovering from surgery
for spinal stenosis with lower extremity weakness. The caregiver partially lifts Mrs. Y’s trunk
to a fully upright sitting position on the bed and minimally lifts each leg toward the
edge of the bed. Mrs. Y then scoots towards the edge of the
bed placing both feet flat onto the floor. She completes most of the activity herself. So how would you score for Mrs. Y? And again, this is a polling question, so
please use your devices. So Code 04 is for supervision or touching
assistance. You would choose B if it’s Code 03 for partial
or moderate assistance. You would push C for Code 02 for substantial
or maximal assistance. And choose D for 01, which would be dependent. And the answer we have most, we have 82% that
chose B, which was Code 03, which is correct. We had 15% that choose Code 02, which is the
substantial and maximal assistance. So again, it’s that deciding factor between
the less than half or more than half of the effort. When we look at the rationale as to why the
correct answer was 03, Mrs. Y required the caregiver to provide limited assistance. That was a keyword there. So it was limited or less than half the effort. It was more than providing verbal cues or
touching or steadying, but it was less than half. So the proper code would be that partial or
moderate assistance, which would be a code of 03. So our last scenario, it has two parts. Mr. W states he wishes he could get out of
bed himself rather than depending on his wife to help. At the start of care, the patient requires
his wife to do most of the effort. Based on the patient’s prior functional status,
his current diagnoses, the expected length of stay, and his motivation to improve, the
clinician expects that by discharge, the patient would likely only require assistance helping
his legs off the bed to complete the supine to sitting task. So this is a polling question. And we’re going to answer the first part of
the question. How would you code GG0170C1? So this is the SOC/ROC Performance coding. How would you score for the patient? Would it be 04, that it was just supervision
or touching assistance? Would it be Code 03, partial or moderate? Would it be Code 02, substantial or maximal
assistance? Or Code 01 for dependent? Okay. So we’ve got a variety of answers on this
one. The correct answer was Code 02. And the description and the scenario was,
at the start of care resumption of care assessment the wife did most of the effort when they
described this. So it was more than half of the effort for
the wife. And we’ll be describe the rationale a little
bit. But that is why Code 02 was the appropriate
answer. And for GG0170C2, so this is for the Discharge
Goal. So you’re there. You’re at the start of care, the resumption
of care. And as you remember, we described in this
scenario that the patient’s prior functional status and considering all the factors that
he expected that the patient would only require assistance, would likely only require assistance
helping his legs off the bed. So this is a polling question. Okay. So it looks like everyone’s completed that. So the correct answer, again this is for the
Discharge Goal. This is for GG0170C2, that the patient would
require the Discharge Goal after assessing all of the factors would be 03, that it would
be partial or moderate assistance. Because as described, the patient would only
require assistance helping his legs off the bed. So looking at that scenario, just reviewing
again the coding. And it takes a little bit to practice this
and to think through the different steps in coding this appropriately. Again for GG0170C1 it would be coded as 02,
because he needed his wife to do more than half the effort to get up and get his legs
onto the side of the bed. And then for the Discharge Goal, it would
be coded as a 03, because they felt that it really would only be that the clinician and
the patient expected by discharge that he would only need the caregiver to assist providing
less than half the effort to get his legs from a lying position and to get sitting on
the side of the bed. So in summary, we’ve talked a lot about the
importance of the covariates for this quality measure for risk of pressure ulcers. And GG0170C is a risk adjustment covariate
for pressure ulcers that are new or worsened quality measure. It’s also a brand new item. I know that you all know that now. It’s added to the OASIS-C2. And it does require observation and assessment,
and is one of those items that will be measured across all settings as described and required
by the IMPACT Act. It also assesses the patient’s usual assessment
using that 6-point scale, and also those three “activity not attempted codes.” And the dash value which is a rare occurrence
to use. It still is a valid response for this item. And Ann Spenard did a great job of talking
about how important it is to take this information and use it as an Action Plan when you go back
to your staff. As seen by the answers, this does take practice. As they say, practice makes perfect. It is a new item. And it’s something that we all need to work
on and practice. And your Action Plan really should be looking
at your workflow, your processes. How do you need to revise them to reflect
the addition of this new measure? And what education plan, Ann Spenard mentioned
using Survey Monkey or using a Blackboard platform. Whatever it is that you use to educate your
staff, but putting in place an Action Plan. Because evidenced by your responses here today,
it is going to take some time so that the nurses are able to score this correctly. And then looking at an Annual Performance
Improvement Plan, because as we know OASIS proficiency is not a one-time thing. It’s something we need to work at consistently. And integrating this into your Annual Performance
Improvement Plan would be a really key area to make sure that your initial education and
work is efficient and accurate so that your scoring is the way it should be. You’ve seen these resources from several speakers
prior to me, so I don’t think I need to read them. But just suffice it to say that there’s a
tremendous amount of information out there. So please know that the resources are there. So I think we’re pretty much out of time at
this point. So we’re going to hold questions for later. But I do thank you for your attention and
thank all of the listeners that are online. Again this is a new item, but we’re really
hopeful that you’re embracing it as a great new item to look at this as a covariate and
accurately measure this across all settings.

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