Home Health & Hospice

Emergent Care Will Mean Emergency Room Care

Homecare Insider, September 28, 2009

In OASIS-B1, M0830, emergent care, has created not only confusion but also possible inequities in outcome results.  Response 3, doctor’s office emergency visit/house call, is the source of the problems.  The Centers for Medicare and Medicaid Services (CMS) has defined any visit scheduled less than 24 hours in advance, no matter the reason, is emergent care.  Examples:  1) A clinic does not schedule appointments in advance.  The receptionist calls and tells the patient when to come in.  If this call occurs less than 24 hours in advance of the visit, this would be emergent care.  2) The patient is due to see the physician for a blood pressure check and prescription renewal in two weeks.  When she calls to make an appointment, the receptionist informs her that the physician will be on vacation at that time, but there is an opening tomorrow.  Because this visit was scheduled less than 24 hours in advance, it, too, constitutes emergent care.  Even though these examples are in no way comparable to true examples of emergent care, including improper medication administration, dehydration, wound infection, and GI bleeding, the agency would incur an adverse event outcome and see less favorable results in the utilization outcome, any emergent care.

After 10 years of these problems, CMS is finally taking action.  The data element in OASIS-C on emergent care (M2300) asks only about any visits to a hospital emergency department.  Soon, the results for emergent care will reflect only emergency situations.  

Beacon Health’s audio conference on October 15 will discuss subtle but important changes in some data elements and introduce new process data elements.  Click here for more about this educational program.