Home Health Prevents Injury From Falls
The Centers for Medicare & Medicaid Services (CMS) continues the process of implementing the Improving Medicare Post Acute Care Transformation Act of 2014. CMS is gradually moving away from the current setting-specific federal assessment instruments that contain varying concepts, definitions, and measurement scales. The move towards cross-setting data collection, quality measurement, and outcome comparison is challenging for home health providers because the home setting has different challenges that are not a factor in determining quality of care in skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals.
The Centers for Medicare & Medicaid Services (CMS) contracted with Abt Associates to develop a cross-setting post-acute care measure on incidence of falls with major injury. In the contract , “Outcome and Assessment Information Set (OASIS) Quality Measure Development and Maintenance Project”, CMS defines Falls with Major Injury as “the percentage of patients who experience one or more falls with major injury (defined as bone fractures, joint dislocations, and closed-head injuries with altered consciousness, or subdural hematoma) during the home health stay”.
CMS called for public comments on this domain in order to gather feedback on importance, feasibility, usability and potential impact of adding falls with major injury data elements for quality measurement as new items to the OASIS item set. Since CMS is moving to connect payment with quality outcomes, this measure could have unintended consequences that could reduce access to home health services and payment for those services.
LeadingAge submitted comments on the Cross-Setting Quality Measure: Falls with Major Injury, specifically noting the needs/concerns/barriers for capturing falls with major injury information using these data elements.
The difficulty with collecting falls with major injury data is how to determine what falls with injury were preventable within the scope of the services provided under the Medicare home health benefit. Medicare home health is a skilled intermittent care service that has limited resources to address some of the potential causes of a fall. LeadingAge agrees the nurse and occupational/physical therapist should be working on fall prevention practices with the patient and caregiver, and the fall prevention strategies may include some environmental changes. Implementing those environmental changes may be beyond the scope of services provided by the home health agency. It may be more important to combine a process measure of developing a falls prevention plan of care and an outcome measure of improving, staying the same or worsening the incidence of falls with major injury.