The Quality Measure for Falls with Major Injury impacts the SNF Quality Reporting Program (QRP) and Five Star. Starting in 2027, it will also impact the Value Based Purchasing (VBP) program. Falls can also have a negative impact during a State Survey.
Falls with Major Injury is a look-back scan measure. It is triggered if a resident experiences one or more falls with major injury on one or more of the assessments in the look-back scan. This is the numerator.
The look-back scan is a 12-month target:
· For long stay residents: current MDS time frame with a max of 93 days plus 275 days for a potential 368 days.
· For Part A SNF stays: the entire Medicare Part A SNF stay specific to a resident, including all SNF Part A stays, in the 12-month target.
For Part A SNF stays an entire stay, or Type 1 SNF stay, is defined as a matched pair with a PPS 5-day Assessment and PPS discharge assessment with no Death in Facility tracking record.
The denominator for this measure is all residents with one or more look-back scan assessments, except those with exclusions.
Exclusions for this measure include:
· Occurrence of fall was not assessed (MDS item J1800 = [-])
· Assessment indicates a fall occurred and the number of falls with major injury was not assessed (MDS item J1900C = [-])
· SNF QRP ONLY – Resident expires during SNF stay (Type 2 stay with PPS 5-dayAssessment MDS items A0310B = [01] AND A0310F= [12] on the Death in Facility tracking record)
On the MDS, item J1900C = [1,2] would indicate a fall with major injury. Major injury is defined as bone fracture, joint dislocations, closed head injuries with altered consciousness, and/or subdural hematoma.
Obviously, poor performance or a high percentage can lead to financial repercussions in relation to the SNF QRP with the annual percentage update (APU), and as noted, in 2027, it will also impact the +/- 2% withhold for the VBP. In addition, for providers in states incorporating QMs into their Medicaid reimbursement through quality incentive payments, the financial effect can be even more cumbersome. The reputational impact of this measure on Five Star and public reporting on Care Compare can lead to further detrimental effects.
State Surveyors use the Accident CriticalAccidentCritical Element Pathway when reviewing falls and their influence on resident care. Aspects reviewed include staff response to resident requests, fall prevention, and positional alarms and safety devices. Environmental hazards are assessed as well as nursing and therapy interventions. Failure to comply can lead to various F-tags and potential Immediate Jeopardy (IJ).
Next, we will take a look at how we can improve this measure.