HHAs Inaccurately Report Falls with Major Injury

Posted Wednesday, September 13, 2023

On September 5, 2023, the Office of the Inspector General (OIG) issued a report showing that home health agencies (HHAs)failed to report over half of falls with major injury and hospitalization among their Medicare patients.

Fifty-five percent of falls we identified in Medicare claims were not reported in OASIS 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 OIG recommend that CMS implement the following corrective actions. CMS agreed with all the OIG’s recommendations.

(1) Take steps to ensure the completeness and accuracy of the HHA reported OASIS data used to calculate the falls with major injury quality measure.

(2) Use data sources, in addition to OASIS assessments, to improve the accuracy of the quality measure related to falls with major injury.

(3) Ensure that HHAs submit required OASIS assessments when their patients are hospitalized.

(4) Explore whether improvements to the quality measure related to falls can also be used to improve the accuracy of other home health measures.

One important recommendation by the OIG is for CMS to evaluate whether automated checks to identify inpatient hospital claims and encounters among home health patients and alert HHAs if the required OASIS assessments are not submitted in a timely manner would improve falls with major injury reporting rates. Patients often experience falls when under the supervision of caregivers when agency personnel are not present. Additionally, hospitals are not always forthcoming on a patient’s condition due to either a misunderstanding of HIPAA rules or simply because of a lack of information that can be shared.  Therefore, HHAs complete the assessment with inaccurate information for patients admitted to the hospital with falls that result in major injury.

Source: NAHC

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