Industry Experts Voice Concerns About New Falls Measure

Posted on Friday, January 13, 2017 4:17 PM

As part of the IMPACT Act of 2014, a new quality measure that indicates falls leading to serious injuries will move forward. Industry experts believe the new measure could be incorporated into value-based purchasing.

CMS received 21 comments about the measure. According to Teresa Lee, Executive Director for the Alliance for Home Health Quality and Innovation, “a major concern the home health industry expressed is that it’s is unique from other post-acute settings but the measure was developed for a setting outside of home health and cross walked to home health and other post-acute settings.”

Abt decided to release a summary report that included the 21 comments about the measure on November 14.

The report includes comments about the overall support for a cross-setting measure involving falls. Some commenters agreed falls are an important concern that could lead to hospitalizations and even death.

The Visiting Nurse Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation noted that the falls measure on which the proposed home health measure was based was not endorsed by the National Quality Forum (NQF) for use in home health agencies. The NQP did endorse the measure, but for use in long-stay nursing homes.

“If a home health patient falls, more often than not that fall is not witnessed by a home health care professional,” those comments state. “A fall with major injury could occur when the patient is home alone, or even in the physician’s office, but it would still be considered a fall with major injury for purposes of this measure if it occurred during a home health episode.”

There’s a question as to whether it’s possible for the measure to be comparable across post-acute settings since in home health, there’s usually nobody present to witness and document the fall and injury at the time of the fall, according to the comments.

As a result, the comments express a concern “about the reliability of the data collection for this measure as it applies to home health care. If a goal is for this measure to be meaningful across settings, standardization is key. At the very least, appropriate adjustment should take into consideration the very different nature of home health in comparison to the facility-based settings.”

The IMPACT Act requires providers including home health agencies to report standardized patient assessment data and quality measure data to CMS. The federal Medicare agency contracted with Abt to develop “Falls With Major Injury,” a cross-setting post-acute care measure.

The measure is defined as the percentage of patients who experience one or more falls with major injury (bone fractures, joint dislocations and closed-head injuries with altered consciousness or subdural hematoma) during a home health stay.
Data likely will be collected on the measure beginning January 1, 2019, and it will likely be publicly reported as of Jan. 1, 2021, Lee says.

In response to providers’ comments, Abt’s report notes in preliminary recommendations that, “We do not plan on making further changes to the measures’ methodology in the immediate future, with the exception of changes to item wording. However, we will take under consideration suggestions for further testing. To the extent possible, we will also incorporate suggestions received during public comment on the implementation of these measures.”

For the full article, please see the January 16, 2017 Home Health Line Edition.

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