Patient improvement on dyspnea is an important factor in snagging a payment boost under Home Health Value-Based Purchasing (HHVBP). OASIS scores on M1400 account for 6% of an agency’s total performance score in 2025, and it’s expected to climb to 7% for 2026 results.
But it's difficult for some agencies to move the needle on this measure. One issue is that a patient's dyspnea can be caused by many different things.
“The ability to improve dyspnea is dependent upon understanding the cause and tailoring the interventions and goals accordingly,” notes Lisa McClammy, senior clinical education consultant with MAC Legacy based in Denton, Texas.
For example, she adds, if a patient is experiencing dyspnea related to decreased cardiac output from an acute exacerbation of heart failure, it is important to understand the stage of the heart failure and the ordered treatments.
Determining the cause will help to develop an individualized plan of care with targeted interventions to improve breathing, adds Robbi Funderburk James, director of coding & OASIS for Healthcare Provider Solutions.
It’s important to note that while strategies may be appropriate for both COPD-related dyspnea and dyspnea from deconditioning, other interventions are condition-specific and may not be suitable for both, she adds.
Interventions might include education on the progression and management of the disease, the importance of medications, fluid balance related to increased or decreased pre-load and progressively increasing activity tolerance to show improvement in the quality episode, McClammy says.
Include interventions in POC
Targeted interventions with the goal of improving a patient’s dyspnea should be an integral part of the plan of care.
“Treating the underlying cause of the dyspnea (asthma, COPD, heart failure, etc.) begins with understanding the disease and teaching the patient to incorporate treatments into their daily routine to prevent future exacerbations,” McClammy says.
This might include medication routines, measuring fluid intake carefully, dietary modifications or walking daily and increasing the time each week, she adds.
And clinicians should ensure that interventions are fully implemented once set.
“In home health, interventions are often ordered and documented in the plan of care but not consistently carried out,” Funderburk James says. “Interventions should be viewed as goal-oriented actions that guide clinical practice.”
Avoid adherence pitfalls
Ensuring medication compliance is another important intervention. That includes understanding the need to continue even when symptoms are controlled.
“Many times, patients will begin to return to normal and feel that they don’t need the medications anymore,” McClammy explains. “However, in most cases, that is not true because chronic diseases generally require medication treatment for the rest of the patient’s life.”
A few examples might include diuretics, bronchodilators, ACE inhibitors, beta-blockers, vasodilators and oxygen.
Determine any triggers
If a patient’s dyspnea is caused by specific triggers, once identified, teach the patient and caregivers to ensure those triggers are not introduced to the patient, McClammy says.
Some examples would be staying away from any setting where people are smoking, avoiding cleaners/scents/candles/diffusers and staying indoors when pollen counts are high.
“While some triggers can’t be completely prevented, there are still ways to help avoid triggers by using air conditioning in hot weather, using scarves or masks over the face in cold weather and controlling emotions when faced with stressful situations,” she adds.
Assessing for oxygen orders
If a patient has oxygen therapy, encourage them to use it as ordered, provide teaching for safety and facilitate portable options as appropriate for greater mobility.
Keep in mind that patients who are on oxygen should be assessed based on the patient’s use of the oxygen, not on the order for oxygen, stresses Diane Link, owner of Link Healthcare Advantage in Littlestown, Pa.
“This means that if the physician orders oxygen continuously, but the patient only wears oxygen as needed, than the assessment for shortness of breath should be made without wearing the oxygen as the patient is not wearing it continuously,” she explains.
The same goes for if the physician orders oxygen as needed but the patient choses to wear oxygen at all times, she adds. “Then the assessment should be completed while the patient is wearing the oxygen as this is what they are routinely doing.”
McClammy offers a few other interventions to consider:
- Therapy and exercise. Therapy and exercise may be used to increase activity tolerance, strengthen respiratory muscles, improve endurance and improve overall health.
- Breathing techniques. Teach specific breathing techniques such as pursed-lip and diaphragmatic breathing to help manage acute episodes and improve breathing efficiency.
Set specific interventions and goals
It can be helpful to outline specific interventions and goals for the patient to achieve.
Here are a few examples provided by McClammy:
Intervention: Skilled nursing (SN) will encourage the patient to begin a walking regimen to increase endurance and activity tolerance and decrease dyspnea. SN will develop a diary to start with five minutes twice daily for week one, increasing to six minutes twice daily for week two, seven minutes twice daily for week three, etc. working up to 10 minutes twice daily.
Goal: The patient will gradually increase daily walking to 10 minutes twice daily, as evidenced by daily diary entries and increased activity tolerance for ADLS and less dyspnea by XX/XX/XXXX (date).
Intervention: SN will teach the patient about managing heart failure symptoms by weighing daily at the same time and on the same scale and recording the weight, managing fluid volume, taking all medications as ordered and maintaining a low sodium and heart-healthy diet, resulting in less dyspnea and improvement in breathing efficiency.
Goal: The patient will have less dyspnea related to heart failure symptoms as evidenced by maintenance of stable weight, reduced/eliminated edema and improved lung sounds by XX/XX/XXXX (date).
Accurately assess for M1400
M1400 (When is the patient dyspneic or noticeably short of breath?) is the OASIS item used to capture dyspnea.
“Because of the structure of the item and descriptions of activities required to produce dyspnea, determining the coding for dyspnea should be incorporated as part of the functional assessment,” notes Lisa McClammy, senior clinical education consultant with MAC Legacy based in Denton, Texas.
To accurately score the patient, read the options from the bottom to the top and stop when you reach the score that describes the level of exertion required to produce dyspnea in your patient, she advices.
This item should not be scored a “0 (Patient is not short of breath)” until you have completed the entire functional assessment, walked your patient 150 feet and climbed stairs to see if the patient has any level of dyspnea during those activities, McClammy says.
“Also, remember to code based on the patient’s actual use of oxygen, not on the order,” she adds.
Use the following examples from the OASIS guidance manual and Q&As to accurately score M1400:
- Orthopnea — When lying flat (day or night)? Sitting? Watching TV? Reading? – Code “4 (At rest (during day or night))”
- While eating? Talking? Brushing teeth? When agitated? – Code “3 (With minimal exertion (for example, while eating, talking, or performing other ADLs) or with agitation)”
- Walking shorter distances of < 20 feet? Dressing or Toileting? - Code “2 (With moderate exertion (for example, while dressing, using commode or bedpan, walking distances less than 20 feet))”
- Ambulating 20, 50 or 150 feet? Climbing stairs? – Code “1 (Walking more than 20 feet or climbing stairs)”
- Patient is not short of breath even after all functional items are assessed - Code “0 (Patient is not short of breath)”