Since the GG items appeared on the OASIS, many clinicians realized the GG items do not correlate exactly with the traditional functional assessment in the M1800s. Clinicians have struggled to score the functional assessment correctly in the OASIS and the GG items are no different. This is largely due to nurses lack of functional training as well as the foreign language the OASIS is written in --what I like to call "Medicare speak."
The main differences between the GG items and the M1800s to remember when choosing the correct response are the following...
1. The M1800s also include mobility along with the self care task being assessed. Example, upper body dressing in M1810 includes getting the clothes out of the drawer or closet, not just the task of putting on a shirt. While GG items separate the two. For example, GG 0130F Upper Body only includes dressing and undressing above the waist.
2. Activities in the GG items assessment may be completed with an assistive device and still be considered "independent" while M1800s typically score lower if a device was used for the task.
3. The GG items allow both a current assessment and a goal for the patient to reach before discharge, while the M1800s are only collected for the time-frame being assessed.
Despite these differences the knowledgeable clinician must ensure the patient described in the M1800s is the same patient described in the GG items section. Although currently our functional scoring is coming only from the M1800's (and M1033) and does not include the GG sections, CMS is quietly collecting data on the patients your agency serves with the GG items today. One of the areas the GG items allows CMS to track is our anticipated outcomes. If your agency is not paying close attention to these I highly recommend your agency consider it.
Below is a list of considerations...
- Are your GG item goals realistic for the patient?
- Are your GG item goals the same across the assessment?
(example -all 06's which mean there is no patient specificity)
- How much of the time are you reaching your goals?
- How many goals are you selecting and why?
(Remember you are only required to select one self-care and one mobility goal)
- Is your care plan written to provide interventions which will help meet the goals on your GG items?
- Do any of your responses indicate your Medicare patient may not be homebound?