Among Medicare home health patients hospitalized for falls with major injury, over half of the falls were not reported on patient assessments by agencies as required, according to an Office of Inspector General report released Sept. 5, 2023.
Due to this high rate of non reporting, Care Compare may not provide accurate information about the incidence of these falls, the OIG noted.
The study identified falls with major injury in Medicare hospital claims for home health patients and then checked whether the falls were reported in the related OASIS assessments. Fifty-five percent of falls 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 agencies as compared to nonprofit and government-owned agencies.
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, according to the OIG report.
OIG offered several recommended actions for CMS and noted that CMS concurred on all points:
- Take steps to ensure the completeness and accuracy of the HHA reported OASIS data used to calculate the falls with major injury quality measure;
- Use data sources, in addition to OASIS assessments, to improve the accuracy of the quality measure related to falls with major injury;
- Ensure that HHAs submit required OASIS assessments when their patients are hospitalized; and
- Explore whether improvements to the quality measure related to falls can also be used to improve the accuracy of other home health measures.