Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients

Posted in Home Care, INDUSTRY NEWS

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

“Fifty-five percent of falls we identified in Medicare claims were not reported in associated OASIS assessments as required. Falls reporting on OASIS assessments was worse among younger home health patients (compared to older patients) and patients who identified as Black, Hispanic, or Asian (compared to White). Reporting was also lower among for-profit HHAs as compared to nonprofit and government-owned agencies. Notably, HHAs with the lowest Care Compare major injury fall rates reported falls less often than HHAs with higher Care Compare fall rates, indicating that Care Compare does not provide the public with accurate information about how often home health patients fell. Finally, for many Medicare home health patients who fell and were hospitalized, there was no OASIS assessment at all associated with the hospitalization, which raises additional concerns about potential noncompliance with data submission requirements and its impact on the accuracy of information about falls with major injury on Care Compare.”

The above statements are a synopsis of the OIG study: OEI-05-22-00290 released this month. The Issue Brief is 34 pages in length.

Starting in 2019, home health agencies (HHAs) were required to report that their patients experienced falls with major injury in patient Outcome Assessment Information Set (OASIS) assessments. The Centers for Medicare & Medicaid Services (CMS) uses this HHA-reported information to calculate major injury fall rates at the agency level. Beginning in 2022, CMS included these fall rates as one of the Care Compare website’s quality measures, which provide consumers with information about HHA performance. OIG and others have found problems with using provider-reported information to assess quality in the past. (OIG) conducted this study to determine the extent of falls reporting by HHAs and implications for the  accuracy of the falls information on Care Compare.

For-profit HHAs failed to report falls more often than other types of agencies. HHAs owned by for-profit entities did not report 56 percent of falls, while HHAs owned by nonprofit and government-owned entities did not report 52 percent and 38 percent of falls, respectively. Refer to Appendix A, Exhibit A-1, for falls non-reporting rates by additional HHA-level characteristics.

Falls non-reporting rates were higher for Hispanic, Black, and Asian people and younger patients. While most falls were among White home health patients, the percentage of falls not reported for White patients was lowest (54 percent not reported). That is, a greater percentage of falls with major injury went unreported for patients who identified as Asian (66 percent not reported), Black (65 percent of falls not reported), or Hispanic (64 percent not reported) as compared to White patients.

I encourage your agency to carefully review and discuss this study then audit your own assessment accuracy for falls with major injuries.  Include a discussion of the Conclusion and Recommendations found in this OIG study.