As mentioned in the New Hampshire Dementia Training Module Six, The Centers for Medicare & Medicaid Services (CMS) plan to incorporate the Brief Interview for Mental Status (BIMS test) to assess for patients’ cognitive impairments as part of OASIS E. Due to the pandemic, a Medicare and Medicaid interim final rule issued last May delayed the new OASIS-E items for at least a year following the end of the Public Health Emergency.*
Note: This BIMS requirement IS coming.
The vaccines are approved, distribution has begun… the pandemic will subside. The current CMS waivers and flexibilities will expire, and Post Acute Care providers will be held accountable for compliance with regulatory requirements. Be ready by implementing early!
Once the federal “Public Health Emergency” status is lifted, CMS will require Home Health Agencies to collect data with BIMS on all discharges and transfers.
What is BIMS?
The BIMS evaluates repetition, recall with and without prompting, and the critical skill of telling time. BIMS alone is not meant to diagnose a dementia related diagnosis, but it can indicate that additional follow-up with a physician would be beneficial to the patient.
OASIS-D does not include a performance based cognitive assessment. The BIMS, which is one such assessment, will provide important baseline information about cognitive function. It’s a simple test that can aid in detecting the presence of cognitive impairment in older adults. Determining cognitive function is essential to creating a valid plan of care and achieving quality outcomes. It is one determining factor in how patients can self-manage their disease state and it’s linked to a higher rate of hospital readmission in Medicare patients. Thus, it’s very important that patients with cognitive impairment have caregivers that can learn how to best manage their disease state.
Brief Interview for Mental Status (BIMS) Video Tutorial
How does BIMS work?
The BIMS is a simple test where a clinician says three words and asks the patient to remember and repeat them. For example, they would say, “sock, blue, bed.” S/he may repeat these same words using cues. For instance, CMS says, a sock is something you wear, blue is a color, and a bed is a piece of furniture. The clinician repeats the words up to two more times. Next, they ask the patient what year it is right now. Then they ask what month it is, and finally, what day of the week it is right now.
After this, the clinician then tests the patient’s recall. They would ask, “Let’s go back to an earlier question. What are those three words that I asked you to repeat?” If the patient is unable to remember a word, the clinician gives the patient a cue for the word.
How do you score the BIMS test?
Upon completion of the BIMS test, one point is assigned for each word the patient initially repeated without cues. Zero points are assigned if the patient didn’t repeat words correctly. The clinician will document if the patient stated the correct year (three points), if the patient was off by a year (two points), if the patient was off by two to five years (one point), or if the patient was off by greater than five years/didn’t answer.
Next, the clinician documents if the patient provides the correct month — within five days (two points). Otherwise, document if the patient was off by a month (one point) or if the patient was off by more than a month or didn’t answer. The clinician then documents if the patient identified the correct day of the week (one point) or incorrect/doesn’t answer.
When the patient is asked to recall the words, two points are assigned for each correct answer without a cue and one point for each correct answer with a cue.
The patient can score 0 to 15 points on the test. A score of 13 to 15 suggests the patient is cognitively intact, 8 to 12 suggests moderately impaired and 0 to 7 suggests severe impairment. As with any other test, clinicians should follow-up with the patient’s physician to verify a diagnosis or to further evaluate the patient if necessary.
The BIMS is currently used in skilled nursing facilities and inpatient rehabilitation facilities, so introducing the test in home health means that when a patient is transferred from one setting to another, agencies will fluidly receive this information and it’ll make it easier to appropriately plan care.
*More to Come
Due to the COVID-19 public health emergency, OASIS-E implementation has been delayed. According to CMS, “HHAs will be required to use OASIS-E to begin collecting data on the two Transfer of Health (ToH) Information Measures beginning with discharges and transfers on January 1st of the year that is at least one full calendar year after the end of the COVID-19 Public Health Emergency (PHE). For example, if the COVID-19 PHE ends on September 20, 2020, HHAs will be required to begin collecting data on those measures beginning with patients discharged or transferred on January 1, 2022.”
For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, click on the link: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.