Home health quality reporting may include more falls data if claims-based information is incorporated into the Falls with Major Injury (FMI) quality measure.
 
An Office of Inspector General report in September 2023 found that 55% of falls identified through a review of claims weren’t reported in the associated OASIS assessments. CMS pointed to this finding in the 2026 Home Health Prospective Payment System proposed rule, released June 30, as it sought feedback on adding an updated FMI measure to Home Health Value-Based Purchasing scores.
 
A technical expert panel (TEP) report, released Aug. 14, goes into more detail on what CMS is envisioning with a refined measure. CMS noted in announcing the TEP results that it “intends to move forward with updates to the FMI measure based on input received during the TEP.”
 
Currently, the measure is primarily captured with J1900C (Number of falls since SOC/ROC — Major injury), with examples offered that include “bone fractures, joint dislocations, closed head injuries with altered consciousness and subdural hematoma.”
 
One potential change for the updated measure would also flag an OASIS with any falls reported and look to match it with a handful of major injury diagnosis codes on claims. A majority of TEP participants suggested this list of diagnosis codes could include:
  • Fracture (Traumatic)
  • Joint Dislocation/Subluxation (Traumatic)
  • Injury to the Head (with and without Loss of Consciousness)
  • Other Non-Fracture Bony Injury
  • Organ Trauma
  • Crush Injury
  • Spine (Cord/Disc)
The TEP panel was split on whether to include falls only reported on claims. While this would catch some falls that were missed on the OASIS, there’s also a greater chance for false positives. Falls are included on claims through an external cause of injury code, but these codes are optional and use can vary, including inconsistent use across states, the TEP report notes.