Home Health Articles and Information


Jan 27, 2020 8:27:00 AM / by Kristi Bajer, BSN, RN, COS-C

The High Cost of Low Functional Scores

The cost of an inaccurate OASIS functional assessment is high under the new PDGM model.  Understanding how the points work within the OASIS assessment is imperative for your QA department. However, it is even more important that your clinicians know how to accurately answer the OASIS functional assessment.  Let's take a look at both the scoring and common reasons clinicians may be missing it.

For example; scoring M1830: bathing as 2-able to bath with intermittent assistance, when a 3-requires assistance throughout, would have been more appropriate will drop the functional score by 10 points!

Because M1033: Risk of Hospitalization requires 4 or more items checked to earn points, missing one answer could cost all 11 points.  The table below compare’s the OASIS responses with the points earned.

Clinicians often answer functional scores in terms of what a patient is actually doing, rather than what they would be safe to do. Clinicians also often do not take cognitive deficits and the need for verbal cues into account when scoring OASIS. Below are a few examples of commonly missed functional scenarios.

1. The patient reports he is bathing alone.  The clinical assessment reveals the patient has an unsteady gait and dizziness as a side effect from pain medication he is taking. The Clinician just considers what the patient is doing and disregards the fall risk due to the dizziness and unsteady gait.  This mistake is worth 10 functional points.

2. The patient is able to brush her teeth and apply her makeup unassisted, but since she has memory loss is often distracted and does not complete the grooming task without reminders.  The clinician reads the highlighted area of the OASIS question "M1800-Grooming" and answers "0- able to groom self unaided", when "2- someone must assist the patient" would have been appropriate. This mistake is worth 6 functional points.

Clinicians must remember all the following possible considerations when scoring functional impairments and determining the correct answer for functional scoring;

  • Physical impairments- ROM, balance
  • Emotional/ cognitive/ behavioral impairments-memory, judgement
  • Sensory impairments- vision, pain
  • Environmental barriers- stairs, storage location
  • And of course, that magic word “SAFELY”

Tags: PDGM, Therapy, Home Health

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.