Watch the full recording here.
This session walks through how small OASIS gaps at start of care and discharge quietly turn into major financial and quality problems, covering:
Case-mix weight — how a single downcoded functional item shifts a patient into a lower payment group
LUPA risk — how one visit moving between payment periods can turn a full episode payment into a single-visit rate
Value-Based Purchasing — why OASIS measures make up 40% of your Total Performance Score, and how scoring drift shows up as a penalty
Star ratings — how they're built at two separate points, start of care (or resumption of care) and discharge, and what happens when either one is off
Referral trust — why hospitals, physician groups, and discharge planners are increasingly filtering referrals by star rating
Building the fix — how a compliance-first coding and risk analysis framework catches these gaps at the point of documentation instead of during an audit
Webinar Transcript
Speakers: Natalie Venable (Thrive Healthcare Solutions), Tara Young (Olli Health), Cortney Swartwood (Host - Olli Health)
Cortney Swartwood (0:00)
Alrighty. So, first of all, thank you guys so much for joining today. I know everybody has very busy schedules. So we appreciate you taking the time to hop on the call today. While we are waiting for folks to join in, I'm actually going to go over some housekeeping notes and some introductions just to make sure that we are getting started on time and then hopefully any late arrivals won't miss too much of the session content. All right, so let's go ahead and get started on some stuff here. So, my name is Cortney Swartwood. I'm the head of marketing here at Olli Health and my job today is basically going to be getting things kicked off and also facilitating that Q&A session. At the end of the webinar, a couple of pieces of housekeeping for you to be aware of. You should notice that everybody is on mute. That's just because of the number of folks that we have joining today. But please do drop any questions that you have into the Q&A box as we are continuing to go along through things. In order to send a question to our speakers, you'll just you'll see a small nine dot grid in the bottom right hand corner of your screen. If you actually click on that, you should see a section called Q&A. And you can add your questions directly there. Depending on time and how many questions we do get, we may not be able to answer everything. Of course, if we don't get to your question live, we will follow up afterwards. And just as a heads up, we are recording today's session and we'll be sending out a link to that recording later today so that you have a copy of it as well. So, please feel free to share that with your team or anybody that couldn't make it to the actual call today. All right. So, we'll go ahead and get into the actual session information here. So, today the session is called why tiny OASIS gaps at the start of care and discharge snowball into seven figure crises and falling star ratings. Of course, if you work in home health, you already know how true this title can be and how a single missed or miscoded OASIS item can really have a major impact. It can ripple through your case mix weights, your VBP performance, and your star ratings all before anybody even really realizes what's happened. This webinar is going to be brought to you by Thrive Healthcare Solutions and Olli Health. Thrive Healthcare Solutions helps home health and hospice agencies strengthen their OASIS accuracy, documentation practices, and overall quality outcomes. And then Olli Health is the most trusted partner for scribe, coding, and quality review, serving hundreds of home health and hospice agencies. We combine the best-in-class clinical AI with certified coders and QA specialists in order to help agencies catch these kind of gaps that we're going to be talking about today before they really turn into bigger problems. And today I am joined by two people who live and breathe this topic every single day. We have Natalie who is the founder of Thrive Healthcare Solutions and Tara who is Olli's director of quality and managed services. So I'll go ahead and hand it over to them, let them do their introductions and tell you a little bit about themselves. And then we'll we'll get started.
Tara Young (4:48)
All right. Thanks, Cortney. Well, good afternoon everybody. My name is Tara Young. I am a home health RN by trade. I've spent the last 24 years in home health. Most of it elbow deep in OASIS coding and the regulations that keep agencies out of trouble. I currently serve as director of quality and managed services here at Olli Health where I spend my time utilizing AI as a tool for diagnosis coding and figuring out why good clinicians still get things wrong. And what actually fixes it, not just what looks good on a policy page. Before that I built my career across quality assurance, client success and clinical education which means I've spent about as much time explaining compliance to clinicians have I as I have explaining clinicians to compliance
Natalie Venable (4:48)
And I'm Natalie Venable. I'm the founder of Thrive Healthcare Solutions. I'm an occupational therapist by trade. Spent a lot of years in home health in the field, business development teams, on quality teams. I've led quality teams. The last several years in the consulting role focused on quality outcomes, regulatory compliance, survey, quapy, medical review, all the things that really tie into protecting your agency and its ability to thrive. I'm OASIS certified, CHAP certified consultant, and a certified lean health care professional. And so I am very excited to be here and I think the fact that you're here speaks to your desire to make sure that your agency is sustaining and growing and that you're investing the right types of resources for that. And so, Tara, I'll hand it back to you. We'll get started.
Cortney Swartwood (7:04)
Thank you both. So, quick look at what we've got lined up for today. This is just the agenda for what we'll be covering. And once I go through this, I'll kick it back over to our speakers and let them take off. So, we'll start with that seven figure ripple effect, which is going to be going over how that one small OASIS gap can really move through your revenue and quality metrics before anybody really even begins to notice. Then we're going to get into the PDGM, LUPAs, and VBP, which is going to be more like where those dollars are actually disappearing once a function item does get downcoded. We're going to then talk about star ratings both at the start of care and at discharge, what your referral partners and consumers actually see and why both of those moments do really matter. Then after that, Natalie and Tara are going to talk through kind of what it looks like to build the fix, how AI coding guard rails and strict risk analysis actually do work together as one big compliance system instead of two separate things. Lastly, we'll wrap with that Q&A. So, do please keep your questions coming. Again, it's the little nine square grid in the bottom corner. If you'll click on Q&A, you can drop your questions there and we'll get to as many as we can. All right, all of that to say, let's get started. I'll hand it over to our fantastic speakers.
Tara Young (8:00)
Okay, thank you Cortney. So, one line item, four ways it cost you. Let's start with a simple but uncomfortable truth. A single miss or miscoded OASIS functional domain item doesn't stay contained to that one assessment. It ripples through your entire agency financially and clinically in ways that often are connected back to their root cause. So let's first talk about case mix weights. Under PDGM, functional impairment level is one of the key drivers of your case mix weight. If you downcode one single item such as transferring, bathing, ambulation, you can shift a patient into a potentially lower case mix group. That drop in payment is often not caught until much later and it also raises your risk of hitting or missing that LUPA threshold where you get paid per visit instead of that full episode rate. With regards to VBP performance, the same coding gap feeds into your quality measures which roll up into your total performance score under value-based purchasing. A few points of drift here can be the difference between an upward payment adjustment and a penalty. And most agencies don't realize that connection until settlement time. So when that claim is being submitted or when it's getting declined or they're having a clawback. Star ratings. OASIS accuracy at start of care or rock and discharge directly shape the outcome measures based in used in your public star rating. That's the number one area where consumers look to see which home health agency they want to choose. Sometimes it's the only option they have to find out if an agency is good enough. Referral sources check those star ratings as well. So by understanding the OASIS item intent, we can directly impact the functional scores which can lead to increased star ratings. And then our referral sources. That's the compounding piece. Lower ratings don't just look bad, they quietly close doors. And I know we've all dealt with this. Hospitals, physician groups, discharge planners, they increasingly filter referrals by star ratings. So a documentation gap today can mean fewer admissions next quarter. So this isn't just a documentation issue. It's a revenue, quality, and growth issue. All stemming from the same root cause. And that's exactly why we're going to unpack what we're going to unpack over the next couple slides. So, how does one gap cascade through your agency? This is a chain reaction or a domino effect that we just introduced laid out step by step. I want you to see it as one continuous line, not six separate problems, because that's exactly how it plays out in the real agency. So, it starts small with one OASIS misstep, one functional item on the OASIS, whether it be bathing, transferring, ambulation, whatever it may be. If it gets coded slightly off, it's not fraud, it's not negligence, it's just a documentation gap, that single item can then feed directly into your case mix calculation. You get it wrong and then the patient's functional impairment level shifts down, pulling that case mix weight down with it. Next, the impact on LUPA risk and PDGM payment loss. The LUPA threshold is not universal. Every one of the 432 case mix group has their own thresholds which is two to five visits and they're impacted by that PDGM clinical group functional impairment level admission source and timing and comorbidity adjustment getting paid per visit instead of that full 30-day payment. That's where the really do real dollars are walking out the door on a single episode. And with the proposed rule coming in 2027, there is 17 case mix groups that have a decrease of one visit for the LUPA threshold, which is great. You don't have to make as many visits, but there's 18 case mix groups that have an increase of one visit. So, where before you were able to hit it at four, now you're going to have to make five visits to be able to meet that LUPA threshold and get paid for that full episode. With regards to VBP total performance score, zoom out from the episode level to the agency level and these coding gaps compound across your patient population. This drags down your outcome measures which drags down your total performance score under value-based purchasing. The same underlying OASIS data that drives your VBP score also drives your public star rating, the one consumers and families and discharge planners see when they're choosing an agency. I know I looked up the star ratings of home health agencies when my mom needed home health. That was the first thing I went to because I was not, in the area where I knew the agency. So that star rating speaks to everybody and patients that have caregivers that are in the health care field are looking at those star ratings. And then finally, your referrals and your revenue erode. That's where it becomes existential. Referral sources, like we said before, hospitals, physician groups, discharge planners, they're increasingly using those star ratings as a filter. The lower the rating, the fewer the referrals, the less revenue. And all that from one line on the assessment. The point of this slide is simple. Every arrow here is measurable in real dollars and real referral volume. This isn't theoretical. It's direct traceable line from documentation to your bottom line. And that's exactly why we built the framework we're going to show you today.
Natalie Venable (14:50)
All right. So, we're going to go unpack some of these things a little bit. We're going to talk about PDGM and that case mix. We're going to talk about LUPA, which stands for low utilization payment adjustment. And then we'll go into value based purchasing. So, we want to give you a little bit more of a deep dive here because these things are a little tricky and they're complicated and the thing is there's a lot of missed opportunity, a lot of money that's left on the table and again Tara mentioned it's not about fraud, it's about inaccurate documentation. So when we think about PDGM, there's an image that comes to mind when I think about PDGM. It looks like a Plinko board. At the top is the admission source timing. Next we have the clinical grouping or the principal diagnosis. After that we have functional impairment level low, medium or high and then comorbidity adjustment which is from the additional diagnoses that are onto the claim. The OASIS is something that gives direct input into CMS's determination of that case mix weight which ties directly to revenue. And so when we think about the purpose of those OASIS items, and I would encourage you if you don't know what OASIS items are used in the PDG on functional impairment level, go look them up because what happens is when you score it, there's a number of points associated with the score that you pick. And so for example, one of the questions that's used is M1033, risk for hospitalizations. That question in and of itself can have a 15% impact on your case mix weight that bump in revenue if you score it correctly. And it's a check all that apply question. What happens? We click a couple, we move on. You want to select all that are appropriate and true for that patient. So, it's really important that which questions are in it. How does your accuracy look? Is your scoring reflecting the true picture? Is it painting the right picture to CMS for your patient? Because yes, there's times when CMS survey medical review, they're going to look at your documentation, but when it comes to upfront payment, it's the OASIS. So, I want you to think about a patient who maybe is fresh stroke, prior independent, and now they're completely flaccid on one side of their body. They need assistance with bathing, dressing, toileting, walking, all the things. High fall risk. When you score these OASIS items, if you tell CMS inadvertently that they're low impairment level, that's going to result likely in a case mix weight that translates to a low amount of resources. Your patient's not very impaired. They shouldn't need a lot of visits. They don't need a lot of services. So we're going to give you fewer resources when in reality that patient's likely highly impaired, needs lots of visits, lots of disciplines, lots of care, and likely that patient was ordered nursing, PT, OT, speech. And you've got to make sure that you're telling CMS the right you're giving them the right information, which ties into accuracy. And I can't I can't say this enough. Just because someone's been doing OASIS a long time doesn't mean that they are following the guidance and scoring. If OASIS were simple, there wouldn't be certifications around it. There wouldn't be big giant books and guidance manuals and how to score it. And you've got to make sure that whoever's doing your QA, you've done your due diligence and inspecting what you expect out of that, which is really what I appreciate. As a consultant, I know that if I refer anybody to Olli Health, all of their reviewers are OASIS and coding certified. So, I know they've been through the same training that I've been through and they understand the value of scoring accurately. Does the score reflect the narrative and so on. So, we've talked about the PDG&M and the functional impairment piece impacting case mix weight, but we also need to talk about LUPA. And your case mix weight determines what your LUPA threshold is. Now, if you've been around a minute, you may remember when the LUPA threshold was just five. All day, every day, everyone, five, get those five visits. It's not that way anymore. So it can range depending on what type of case mix weight the patient has. And so we want to make sure that we're giving CMS again the correct info so that we get the correct case mix weight and we have the correct loop threshold. Now, why is that so important? I want to give you an example. Let's say that you have a HERG score that translates to a case mix weight that's worth $1, 500 per pay period. So, our 60-day episodes are broken down into two 30-day pay periods. And Tara mentioned there's 432 case mix weights for pay period 1 that you could grab, 432 for pay period 2. If nothing changes between the two, it will the case mix will stay the same. So, you'll have 1, 500 here and 1, 500 here if you meet the LUPA threshold for each 30-day pay period. So, let's say that your LUPA threshold is two. So, you got to have two visits in pay period one, two in pay period two. Let's say you've got six visits total scheduled across the episode. Four in pay period one, two in pay period two. And let's say one of those visits in pay period 2 is on a Tuesday and it's scheduled on day 31 and we move it back a day to day 30. Now you've got five visits in pay period one which means you've still met the threshold. You're going to get that $1, 500. Now you've only got one visit in pay period two. You need two at a minimum. You've only got one. And if you miss this oversight, that means instead of getting that full $1, 500 for that second pay period, you're going to get paid at a per visit rate, which is likely going to be somewhere between $150 and $300 depending on which discipline it is. So, you've lost over $1, 000 like that. Now, obviously, there's scheduling oversight that goes into this utilization. And are we proper properly planning out frequencies and so on? But you want to make sure that when you score the patient in your OASIS, it's scored correctly so that you get the right LUPA threshold because it makes a difference and moving one visit can translate to a lot of missed revenue. It happens all the time. One wrong click, one missed opportunity. And it can be as simple as, Tara mentioned ambulation bathing. I hear this all the time. Oh, if you're not sure, just score the one below it. Wouldn't recommend that. There's some items that if you score the one below it, the one below it's an independent item. They're not they are not necessarily listed in order of required assistant. Bathing is a perfect example of that. So you want to make sure whoever's reviewing is doing a thorough job and they understand the guidance. So far this is just PDGM loop threshold. This same error doesn't stop here. It follows the record into value-based purchasing. And so PDGM is really that how much do you need right now to take care of this patient? Value-based purchasing is well did your patient get better? Did they have a good outcome? Did you keep them out of the hospital? And did they have a good experience? So the OASIS piece of that is 40% in the current model if you if you have enough you meet the bare minimum requirements for each of the three U claims OASIS and HCAPS. OASIS 40%. And there's some overlap between the OASIS items that are in the PDGM functional impairment level calculation and in VBP, but they're not all the same. And so I don't want you to think, oh, these are the only ones we need to focus on. The entire OAS is important for the purpose of, what's impacts PDGM is not all the same as that impacts VBP or STARS. There is some overlap, but then there's additional items outside of that impact risk adjustment. Which is a whole other thing that you want to make sure cognition social determinants of health, health literacy, all of that is going to impact risk adjustment. So, you want to make sure that you're scoring those correctly as well. Another thing I want to point out is the discharge function score that's weighted 15% in the OASIS 40% calculation. Discharge function score is 15%. That is GG item specific and the discharge function score is not just about did your patient move from a four to a five an improvement it's about meeting an expected score of improvement and when you've got a reviewer who knows the regulations who knows the guidance they know I got to score this for accuracy this isn't just about a oneup code or a one down code and you don't want to miss that opportunity I encourage you heavily If you've not looked at your annual performance report or your interim performance report for value based purchasing, you need to look at it because it's going to give you insight to where your opportunities lie. We just got the annual performance reports in August for your payment adjustment in 2027. If you've got a negative payment adjustment coming to every claim that you bill, every Medicare fee for service claim you bill, that report from August will tell you why. And it will tell you where your opportunities live. And if you have an EMR or you've invested in a solid QA company that gives you insights into your real time trends, you can proactively address them so that what you're doing now when CMS starts to capture it and it impacts another payment year, you're fine because, you've addressed it in real time. Where your areas of opportunity is. You will pay for your performance now. One way or the other, you will reap the benefits of good outcomes or you'll pay for it. And there's so many tools and resources available to you to invest in your organization so that you can proactively, address those trends that you're seeing and just score well upfront at the point of care at the beginning because it all translates into dollars and it silently compounds. I hear folks say often, "Oh, I'll outgrow my negative payment adjustment in value based purchasing." I've never seen that happen. Never seen that happen. Because every person that you admit, especially if they're the best payer source, Medicare, you're still going to pay a penalty on that if you've got a negative payment adjustment. So it can be tricky, but those reports are there for you to use and interpret. And if you're having trouble interpreting those, we encourage you to reach out to us, whether it's Olli Health or me at Thrive Healthcare Solutions. We can help you interpret what those reports are saying and how to strategize moving forward. Though VBP isn't the last stop. Star ratings is the next step in your outcomes.
Tara Young (25:26)
Yep. Thanks, Natalie. Star ratings are built at two moments. We have a beginning and an end. We have a quality episode, and that quality episode is defined as your start or most recent rock to your discharge. So, we want to look at everything that's happening in between there. It's easy to think of the OASIS as one long form you fill out once, but if you are a home health clinician or QA, that we fill out OASIS after OASIS after OASIS after OASIS. But really when you're looking at that quality episode, you're looking at two specific time points to do all the heavy lifting for your star ratings. If either one is off, then the rating built on top of that is going to be compromised. So, your start of care or your most recent rock, this is going to be your baseline where you start from. This is where you want to capture how acute your patient really is. And you want to put your OASIS glasses on and answer the questions based on the OASIS guidance. You want to remember that the OASIS is an assessment. It's not an interview. So, you're going to have to get your patients up out of their chair, walk them to the restroom, have them, sit down and stand up off the commode, maybe step in and out of the tub, go into the bedroom where they keep their clothes, have them kind of go through the motions of how they get dressed and get changed every day because that's what you are assessing their safe ability to do. If you understate their limitation at this point and go by maybe what their caregiver says they're doing or what they report they're doing versus actually assessing them doing it, you have created now a ceiling because if you mark them as functionally independent in grooming, you have no room for improvement. Our goal is to capture the patients as acute as they are at start of care or most recent rock and then improve them over the next 30 to 60 days. Every real improvement that your clinician achieve afterwards looks smaller than it actually was if they've not documented correctly on the front end. You're measuring against an inflated starting point. So again, don't document what they're telling you. Document what you're able to observe. And when I say put your OASIS glasses on, you want to observe how your patient is completing the task safely. Just because they live alone doesn't mean they're independent in every ADL task. They may be doing it by themselves, but that doesn't mean they're doing it safely. And then we get to discharge, and this is where the loop closes. Discharge OASIS is actually what is going to calculate that outcome. You're going to see an improvement, a stabilization, or a decline. Improvements in mobility, self-care, disease management, all of it. If your discharge documentation is rust or if it's an interview again versus an assessment, you can literally erase any clinical gains your team worked so hard to achieve. The patient got better, but the data doesn't show it. Make sure if therapy was involved, you're looking at their discharge summaries to see how they scored their patient. I say this all the time. I'm a nurse and I just give it hands down to our therapists, Natalie included. I just feel like they do a better job of assessing the patients functional scores. The nurses really focus on the wounds and everything, but at the end of the day, any clinician that's completing an OASIS needs to understand what CMS tells us in that guidance manual on how to approach each one of those questions. Like Natalie said, if you just go one down for bathing, for example, if you go from a three to a four, you just made them dependent to independent in the shower or tub. And I don't know of the patients you've dealt with, but I always put this scenario back on my clinicians. If that was your grandmother, would you let them take a sponge bath at the sink or at the bedside and wash all those hard-to-reach areas? Would you let her do that by herself if this was her clinical picture? And that is really going to kind of turn the light bulbs on for your clinicians. So, the risk runs in both directions. Overstate your functional start care or rock and you shrink your apparent improvement. Understate their function at discharge or just document it carelessly and you lose credit for all the work you've done over the past 30 to 60 days. Either error at either moment distorts the number consumers and referral partners are using to judge you. That's why we say star ratings aren't really built at once, they're built twice. At two vulnerable moments in the patient stay, get both right and your ratings are going to reflect your actual quality of care. Get either wrong and you're leaving performance on the table that your clinicians already earned.
Natalie Venable (30:43)
And I just want to point out just recently OASIS was is now required all patients, all pairs. And there's talk at quality outcomes reporting in the future. All of that's going to be used for public reporting for your star rating. So if you've got the mindset, well, I only need to have my Medicare Advantage OASIS scores pristine. Not true. Everybody needs to be scored accurately on OASIS because CMS is looking at it. So, and again for the star rating, timely initiation of care goes into that. Potentially preventable hospitalizations go into that. Some of those things tie into value based purchasing. So, there are lots of areas of opportunity where you can kind of kill two birds with one stone just by focusing on one really heavily weighted thing. So star ratings in particular is kind of Tara spoke to it earlier, but it's really the main thing people are using to judge your agency and you've typically got two types of star ratings. Your quality star rating, which pulls in that OASIS data, and then you've got your HC caps or your survey data. So, let's let's talk about your quality star rating from the OASIS. It's a report card. Are your patients improving or not? And nobody's going in to read your documentation and how, happy they were. We loved your agency. It's the star rating. And if you're not scoring that OASIS correctly, as Tara mentioned at start of care, resumption of care, and discharge, you're not going to paint the right picture to the public. And so that star rating is not just a reflection of if your patients improved, but it's really a reflection of do your clinicians know how to score OASIS accurately. And you don't want your star rating to reflect something that's not the truth. I'll tell you why. Because lots of times hospitals, sniffs, long-term care, they will print out, they'll put your zip code in filter the star ratings by, five and down. And they print it out and say, "Here you go. Five stars is good." So, pick patient choice, right? They have right to choice. So if you're two stars, two and a half, three, they're probably not going to pick you because they're probably going to lean towards those higher star rating. And, I don't know what your star rating is. And I'm not saying that to put anyone down, but that's the way we work as humans. When we're looking at a restaurant, we're looking if you've got two McDonald's in your zip code and one's one star and one's five star and they've got a substantial amount of reviews, you're probably going to lean towards a fivestar restaurant. And it's the same concept. And it makes it really difficult for your sales business development teams to sell that as a value proposition when your star rating doesn't accurately reflect the care that you provide or the outcomes that are truly happening. I in my own experience have lost referrals because of a star rating drop and it takes a long time to recoup that star rating because there's such a lag time in the data. So what you do now isn't going to be reflected in a star rating until 36 months from now. And so that's why you got to make sure what you're doing now is true and accurate so that by the time CMS gets to reporting it, it's true. And that's really going to equip your sales and business development teams with really great tools for selling because you can't argue with the star rating. It speaks for itself. And you don't want to lose those referral sources because again, it can take a long time and a lot of ACOs and different hospitals, they have requirements like we expect this and as soon as you fall out of that, you're off the preferred list. But unfortunately, it happens, but it's the truth. And so, proactively looking into how you're being scored and where your opportunities lie will prevent this from happening. Okay. And so, the fix, we've talked about casting it at the source, the point of care, giving your clinician some onus and the OASIS accuracy, but also building in those guard rails of inspecting what you expect of your reviewers. Are they certified? If they're not, are they well versed in the guidance and do they understand which items impact what and the risk associated with inaccuracies and then being able to analyze your risk. That's what I do a lot in my business is a lot of risk analysis, looking at where opportunities live. Where are you leaving money on the table? And again this is not about inaccuracies. This is not about being fraudulent. This is just about giving yourself credit and capturing the true picture so that CMS gives you the right amount of resources that you need and your patients deserve and that your data reflects the truth of what you're out there doing with your patients. And so again encouraging you to look at your case mix weights, look at your functional impairment thresholds, where are you trending and your value-based purchasing reports to understand what does the data say and where's your opportunity so that you can move the dial quicker. Tara
Tara Young (36:41)
So just to kind of piggyback on what Natalie shared, catching it at the source. I always use the acronym only handle it once, Ohio. The early Earliest and cheapest place to fix an OASIS error is at the point of documentation. So before that OASIS is locked, before it's submitted, once it's locked into a claim, you are in correction and appeals territory and nobody wants to be in that territory. Reviewing accuracy at the point of entry means the clinician gets a chance to fix it in real time, not three months later during an audit. And making sure the team members that are doing the audits are giving feedback to the clinicians. Natalie and I Natalie and I joked that we hear it a lot that the QA team is the cleanup crew. The clinicians are like just answer it the best you can and QA will fix it. Well, at the end of the day, we want the clinicians, like Natalie said, to own that OASIS. It's their documentation. They were in the home. They did the assessment. And what we want to do is educate them so they understand again that item intent. Put on those OASIS glasses, understand the item intent for the question. Have them assess what the patient's doing safely, not whether they're willing or compliant in doing it. How they can actually do it safely. Building in your guard rails, consistency is the real enemy here. Two clinicians can look at the same patient and score functionally functional items differently, not because they're wrong, but because their scoring logic isn't standardized. And we do know that we have our M1800s and then we have our GG items. They should paint the same picture, but they're not one for one. They're not analyzing the same thing. When they're looking at ambulation, they're looking at how many steps they can take, how many stairs they can ascend and descend. And in the functionals, it's one question, M1860, just ambulation. So you want to make sure that your clinicians understand the logic behind those two separate sections within the OASIS. You want them to apply the same criteria. And like Natalie said, we're now submitting all payers to OASIS. I want my home health clinicians to understand OASIS. I want them to be completely blind to who the payer is. I want them to consistently answer the OASIS the same way and understand the guidelines. And I don't want them to look at the OASIS differently because it's a Medicaid or a self-pay or a Medicare. One thing that I've seen just kind of in my years of working with OASIS is clinicians are sometimes nervous about scoring their patient as less depend less independent. I can't score this patient a three at ambulation because I have to go see my next patient and I can't document that they're not safe unless somebody's with them. Well, you have to remember they didn't come to this level of functioning overnight and we're not going to improve their level of functioning in a 2-hour admission visit. That's why we have a 60-day episode to improve that patient. You assess your patient, you document their acuity, you refer to the physician and let them know what's going on because now you may need a social work referral, a PT or an OT referral. Base. On what your assessment determined about their level of risk. So keep that in mind. You're not at risk if you mark them a three for ambulation. That is setting your plan of care up for success by getting those additional disciplines in place. And then analyzing the risk. This is your proactive layer. Doing all this up front instead of waiting to find out your TPS dropped or your star rating slipped, you're flagging the patterns on the front end, the specific items, the specific clinicians, the specific trends. They put those scores at risk before the survey season. So, assess that upfront, give your clinicians feedback. And notice these three aren't sequential steps that you do once. They're a loop. You're constantly doing it. You're constantly reviewing, catching errors at the source. Feed your guardrails. Guardrails reduce your risk analysis, what your risk analysis has to catch. And your risk analysis tells you where to tighten the guardrails next. It's going to lean you into what do I need to present at case conference next month. And I've I've said this for 15 years, if you try to teach the whole OASIS to the whole staff at every case conference, you're going to begin to sound like the teacher from peanuts. Your clinicians are going to be completely disengaged. But if you're able to trend specific errors for specific clinicians and show them what they documented versus how they answered that OASIS question, the light bulbs are going to begin to go off. They're going to understand the process that much better the next time they complete an OASIS. And this is exactly where AI powered coding support and structured risk analysis comes together. Not as separate tools bolted on, but as one compliance ecosystem. And that's what we want to show you next. So, what do we do here at Olli? We are a tech company that does AI enhanced coding with OASIS and Planet Care Review. We didn't want to give agencies two separate tools that each solve half the problem. We built one ecosystem that closes the loop. As a clinician is scoring a functional OASIS item, our team is checking that scoring in real time. So the clinician completes their visit. They sync their assessment. It comes to Olli and we're giving feedback within that 5-day window. You're not relying on individual judgment calls to get case mix or outcome data right. That's the piece that stops that seven figure ripple effect before it even starts. We use AI in referral document review. It's looking at your physician's orders, your referral documents, as well as what your clinician is documenting as their focus of care to determine the most accurate primary diagnosis, which establishes that PDGM clinical group, and then your comorbidities, which can get you that adjustment. Our human team uses AI as a tool when reviewing the case. So, it's not just a computer looking at your chart. We use it as a tool. On the other side, Olli is continuously reviewing trends by OASIS type, clinician, and by time period. So, we're giving the agencies back a scorecard. We want to catch that drift early. So, if one clinician is consistently scoring a domain differently than their peers or if a specific item such as M1400 is trending, we can catch that early on and help your team educate on that. The compliance ecosystem, this middle piece is really the whole point. The overlap is where the survey penalties and revenue loss get caught before they compound. So, let's identify those opportunities on the front end, educate our clinicians, and then hopefully they're stronger on the back end.
Natalie Venable (43:03)
And Tara, if I could just add there, there are a lot of products out there and that are AIdriven. And I just want to caution folks when you're looking at these and you're looking at who should you invest in. You need to inspect what you expect and do your due diligence and ask questions about how those guardrails are built around their AI products. Is a human involved in checking it? Was a human involved in building it out? Because there are a lot of tools out there, particularly ones that are scoring OASIS, that aren't scoring it correctly. And who's responsible for that outcome? You are. So, make sure you ask those questions. And, don't lock yourself into a big long contract if you don't trust that what they've got going on internally is good and solid and integrous. Such that you've got this compliance ecosystem truly at the core of what you're doing because that's what matters. That's what's going to protect you. That's what's going to make you the most fruitful and thriving and sustainable. And that's what's going to give you those outcomes that you want because it's going to paint the pictures, but what's actually happening in your organization related to your patients are generally improving and getting better. And that's that's what you want. And you're the one who has to paint that picture with your OASIS.
Cortney Swartwood (44:19)
Okay, fantastic. I think we are right around the perfect time for us to take a pause. I haven't seen any questions come through on the Q&A panel. So again, reminder for everybody, I know there are a couple folks that join later. But you can select that little grid in the bottom right hand corner of your screen in order to be able to submit questions to the team. Otherwise I can also we can talk about a couple of really common questions that do kind of pop up as we go through. And I put up these two QR codes for while we are chatting about this. These are QR codes that'll take you directly to Natalie and Terra's LinkedIn if you guys want to get connected. You have the ability to do that and so I'll leave that up on the screen for just a minute. All right. So, one of the common questions that we get and this would be for Tara. I think both you and Natalie would be able to answer this. So, let's assume that we have maybe a smaller agency who maybe has like less than 100 for their ADC. How does kind of that one bad OASIS assessment impact them? Is it still a problem for those smaller agencies or is it more of a big agency issue?
Tara Young (44:19)
I was going to let Natalie handle that one.
Natalie Venable (46:31)
Okay. So it's going to matter for both. So if you're smaller, you may be in the small cohort for value based purchasing. If you're bigger, you may be in the large cohort. So if you're large, one negative outcome for your OASIS, your star ratings, VBP, you're not going to feel that so much. Whereas in a smaller agency, you're going to feel that a little bit more. But the thing I want to point out, I mentioned risk adjustment. Risk adjustment is what CMS takes into account about your agency. So, they're look they're going to look at the size. They're going to look at the demographics of your patient. They're going to look at the most common diagnosis, cognition, health literacy, social determinance of health, and all of those things are going to help them kind of level the playing field, if you will. So, if you've got one agency over here that's got a lot of sick patients who need a lot of help and then you've got another agency over here who maybe is much bigger and most of their patients are joint replacements much easier to deal with, much quicker turnaround, easier to keep out of the hospital generally than this group. What CMS does with that risk adjustment is they level the playing field. And so I would say the goal would be don't focus on your size, just focus on accuracy. And that's going to that's going to pay for itself in the long run.
Cortney Swartwood (46:31)
So we have had a couple of questions that have come in. So, thank you guys for submitting those. So, the first one is, "What do you recommend to reduce hospitalizations? Our outcomes actually look pretty good, but we struggle with the PPH metric.
Tara Young (47:32)
So, that one is number one, getting your assessment right on OASIS, answering M1033 correctly. Like Natalie mentioned earlier, go in there and really have your clinicians look at all of those. Those answers at the bottom that don't get you any additional points really do help you build a more robust plan of care. So, you really need to look at those other scenarios like maybe the patient has multiple animals in the house and they have an open wound and they let their dog sleep in the bed. Maybe they have 150 ft of oxygen tubing that could potentially lead to more falls which could cause a rehospization. So really look at your M1033 responses. Is to see if you can number one build a more robust plan of care and then also front-loading those visits. Incorporating telehealth, making sure that everybody that's involved with that patient understands their medication regimen. They may have caregivers that are coming in filling their medication boxes and nobody knows who's on first. Nobody knows who's filling the pill boxes. The patient doesn't know what to take. So really doing a good med reconciliation and med teaching on the front end as well as frontloading visits.
Natalie Venable (48:39)
And then if I could add to that, I would say one, make sure everybody in your organization understands the definition of a potentially preventable hospitalization. So it hospitalization, we used to be focused on acute care hospitalization, which was that first 60 days. Potentially preventable hospitalizations can happen at any point in time regardless of how long the patient's been on service. And there's some and you if you go to the CMS website, particularly the home health center, and you go to the bottom of the page, you'll see a technical report on how they calculate all of these things. And when they talk about potentially preventable, they're looking at things that could likely have were mismanaged or could have been prevented. So things like patients going to the hospital for dehydration, medication errors, falls, exacerbations related to CHF, that type of stuff. So if your EMR or you've got a some type of data analytics that will allow you to look into is it a particular referral source of patients that are hitting your PPH? Is it a particular diagnosis code? If you look at region for transfer, what is trending there? And then kind of take a deep dive to see what are we not weighing our patients or do we have signs and symptoms for UTI that we're not acting on it? Is it because our contract therapists aren't talking to our own staff nurses? And then in addition, I just want to add potentially preventable hospitalizations also includes observation stays whereas before it was only true in patient admission. So PPH includes inpatient and observation stay. So it's really important that you look at how do we keep our patients out of the hospital. Zolum tools I think are a great example a great strategy as well. So when you take what Tara said on that front end accuracy and then you kind of take what I've said and you build that out on the patient's journey that and then do some risk analysis that will kind of help you get a feel for where does your opportunity truly live through that root cause analysis if you set everything up front just right.
Cortney Swartwood (50:54)
Fantastic. Thank you both. And then we have another one. So, with or without ambient AI, do you teach the room by room assessment or the OASIS walk to help assure better data capture versus interviews? Standardization for me is key with of course individual adapt.
Tara Young (50:54)
That would really go back to the individual agency level, but I highly advise you do as part of your orientation for your new hires, teach that OASIS walk and teach your clinicians how to answer several questions with that OASIS walk. Asking your patient, can you go and get your medications for me and then tell me what they're for? That gets your patient up and out of their chair, maybe walking into their bedroom or their kitchen. You can observe how safely they're ambulating, getting their medications, bringing them back, having them explain their medications to you so you can establish what their vision is and then their understanding on medications. So, I mean, it goes without saying, the OASIS is an assessment and not an interview. And whenever we give feedback to clinicians when we're making a recommendation to change one of their OASIS responses, we give them the chart documentation to back up our recommendation and then the OASIS guidance to kind of seal the deal.
Natalie Venable (51:56)
And to add to that piggy back remembering that you've got that five-day window from the start of care. Started care counts as day zero and then you've got five days to complete the comprehensive assessment. So back when I was in the field I partnered with whoever is doing the start of care. This is before OASIS could do start of care and my nurse may say, "Hey Natalie, the patient was super weak. I wasn't able to do a toilet transfer. You're going in this afternoon or tomorrow. Can you let me know what you find?" And if I was able to get the patient to do that, I would let her know what I found. And the guidance says there's one clinician rule, whoever does the OASIS owned it, that they're allowed to collaborate with other disciplines within that comprehensive contra window. So that you're painting the accurate picture of what's happening truly happening with that patient. Yeah. Always just walk all day every day at and at every time point not just the start discharge discharges.
Tara Young (52:53)
Okay. And that's one thing you can tell with clinicians. If they're not doing it consistently and you go on a co- visit with them and they're fumbling through the OASIS walk, that's a trigger that they might not be doing it every time if they're not comfortable doing it when you are coming along with them. So I you just need to establish that on the front end that this is a non-negotiable. You have to get your patients up obviously safely to do that OASIS walk.
Cortney Swartwood (52:53)
Okay. We still have a little time. So, next question is, what do you recommend with those patients who come on service with limited rehab potential? We sometimes open cases for patients who have been bedbound for many years and it's clear at the beginning that they will not improve those functional items. It will be geared more towards CG education.
Tara Young (53:50)
I think that's an honest question that happens a lot with agencies and I think with every group of patients that you get that do show improvement. You are going to have some patients that are just not improving. You want to make sure that you're documenting accurately based on what is presenting to you on your assessment. And then again, if you're providing the patient with caregiver education and you're making the caregiver more independent with the care for that patient, at the end of the day, you're you're meeting the needs of that patient. But you might not necessarily be able to show improvements. Natalie, any thoughts on that one?
Natalie Venable (54:45)
I second that. And I just want to take it back to risk adjustment of making sure that you've got the right diagnosis codes, that you're scoring the patient's prior level of function questions accurately on the GG items. There's the questions, is the patient able to walk 10 feet on a level surface? Are you selecting the correct activity not attempted code? To reflect that the patient can't do it now and they couldn't do it before. So this isn't even an option, right? And so Medicare takes those things into consideration when they're looking into VBP and star rating producing those numbers. So, so know that if you're painting the right picture with your OASIS, they'll take that into consideration. I mentioned earlier leveling the playing field. That's that's what's happening there. But you got to paint the right picture.
Cortney Swartwood (54:45)
Okay. And we have one more it looks like. So, if a patient is only on OBS, do we need a TR and rock or only full admission?
Tara Young (54:45)
You wouldn't want to do the transfer unless they were admitted. I believe it's for 24 hours and then you would need to do the ROC.
Natalie Venable (54:45)
For 24 hours. Step.
Tara Young (55:51)
If they go in under observation, they're never fully admitted and they come home. You do not have to do that. That's a lot of unnecessary documentation if you accidentally do it when they've been in observation. And sometimes it's not clear and sometimes the hospitals will really mess with you because they'll mark them as observation and you go about your day and just do a regular visit and then you go back and get a discharge summary where they were changed to an admit. Then you do have to back up and punt and do that transfer and ROC.
Natalie Venable (55:51)
And if you want specific fix on that. If you go into the OASIS E2 guidance manual for 2026 or you go in and you look for the OASIS Q&As, you can see specifically the guidance around certain scenarios like that or what do I do if they hospitalize in the last 5 days before the research and they come back on day 59. There's some really specific guidance on what to do so that you are following the correct steps and you've got the right sequence patterns in place. We said OASIS is not easy. It's tricky. And so, the fact that you're here, I think, speaks to your level of integrity and care. And so, we appreciate that. Lots of resources. Just, let us know what you need.
Cortney Swartwood (55:51)
Fantastic. Okay, any last minute questions?
Tara Young (56:56)
It looks like Steve had a question about discharge function score. So looking at CMS method methodology for their prediction of a discharge function score. If it appears to predict limited rehab potential, I believe it's a greater indicator for hospice potential as it uses a number of data points for from the in-person assessment and research data from CMS. What am I missing? That's one thing. If they are discharged to hospice and it's appropriate and it's documented correctly, you're not going to get gigged on that. So, that's one thing to consider. For those potential hospice patients.
Natalie Venable (56:56)
And that's going to be specifically M2410 and M2420 scoring those correctly to reflect that the patient was transitioned to hospice. That will not be counted. The patient's outcomes will not be counted against you evaluate for your star ratings. If you score it correctly
Cortney Swartwood (58:10)
Apologize for missing that last one. It looked like it did not want to come up on my screen. So, thanks for catching that one, Tara. And also everybody, I have put up the meet the companies slide here and that's just going to be able to get you connected to both Thrive and Olli if you guys have any additional questions there. But we've got about three minutes left before we hit the top of the hour. So, I think we are good to call it now if I don't see any additional questions. So, Natalie, Tara, thank you both so much for walking us through this. I think it's pretty clear, how much these small little OASIS gaps really can add up to financial and quality consequences. And I think everybody that's on this call will be able to walk away with a much clearer picture of where to look at this point. Last couple minute couple of notes in the last couple of minutes. There we go. As a reminder, the session is being recorded. We'll send it out to everybody later today. Feel free to share it out with anybody on your team that couldn't make it. And if today's conversation, had you thinking about where your own agency might have blind spots, Olli Health does offer a 30-day pilot that you can opt out of at any time. This way, you can see firsthand how our combination of AI and certified coders and QA specialists catches these kinds of gaps that we talked about today. I'll drop a link in the chat if that's something that you want to explore, so you can actually take a look there. And then thrive's focus is in quality outcomes, clinical excellence, and regulatory compliance, which all tie in to an agency's ability to thrive financially. So whether you need help understanding your VBP reports, strategizing how your quality is impacting your revenue, or just understanding a new regulation, Natalie is a really great resource. All that to say, thank you guys so much for joining us. Again, thank you to Natalie and Tara and Thrive Healthcare Solutions for partnering with us on this today. And I hope everybody has a fantastic rest of your day. And we will talk to you next time.
Natalie Venable (58:10)
Thanks for having me all.
Tara Young (58:10)
Byebye.
