OIG Says Most Agencies Failed to Report Major Falls

WASHINGTON—Home health agencies didn’t report more than half of the falls that Medicare home health patients hospitalized for falls with major injury experienced, according to a new study by the Department of Health and Human Services Office of the Inspector General (OIG).

The OIG said the findings call the accuracy of Care Compare’s information about falls with major injury into question, and it recommended that the Centers for Medicare & Medicaid Services (CMS) take steps to ensure that HHA-reported Outcome and Assessment Information Set (OASIS) data is accurate and complete, among other measures.

The report looked at almost 40,000 falls with hospitalization and major injury—including subdural hematomas and broken bones—that were submitted through hospital Medicare claims for home health patients from more than 6,000 agencies. It then checked whether those falls were reported in OASIS assessments for those patients, as has been required since 2019, and calculated non-reporting rates.

According to the report, 55% of the falls identified in Mediare claims were not reported in teh associated OASIS assessments as required. The rates were worse among:

• Younger patients vs. older patients
• Patients who identified as Black, Hispanic or Asian vs. white patients
• For-profit HHAs compared to non-profit or government-owned agencies
• Medicare Advantage enrollees vs. traditional Medicare

“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,” the report said. “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.”

For example, it said, one agency in Florida with a five-star Care Compare rating reported none of the 18 falls with major injury its Medicare patients experienced between July 1, 2020 and June 30, 2021.  

The report said that HHAs should have practices in place to monitor their OASIS accuracy, including clinical record audits, data entry audits and reports based on electronic health records. It also said that most state agencies do not take steps to ensure OASIS completeness and accuracy in their home health audits.

The OIG recommended that CMS:

• 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
• explore whether improvements to the quality measure related to falls can also be used to improve the accuracy of other home health measures. CMS concurred with all four recommendations

CMS concurred with all four recommendations and agreed to explore or look into the suggested measures.