CMS to Assess the Accuracy of Fall Reporting on MDS

• By: Maureen Carland
• On: 04/04/2024 16:12:25
• In: Quality/Regulatory

The Office of Inspector General (OIG) maintains a flexible work planning process, adjusting priorities throughout the year to address emerging issues with available resources.  This month the OPIG has identified falls as an area of focus.  

Nursing homes are mandated to document resident falls in patient assessments, with CMS utilizing this data to gauge the proportion of residents experiencing falls resulting in significant injuries at each certified nursing home. These figures are publicly available on CMS's Care Compare website. This study aims to evaluate the accuracy of patient assessment data used for calculating nursing home fall rates. Specifically, CMS will utilize claims data to identify hospitalizations stemming from falls with major injury among nursing home residents enrolled in Medicare. They will then cross-reference this information with patient assessments to determine the extent to which nursing homes reported these falls and investigate the characteristics of individuals whose falls were not reported. Additionally, CMS will analyze the characteristics of nursing homes that failed to report falls among their residents.

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Staff contact: mcarland@mehca.org