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In the first “national-level assessment of how nursing homes self-report major injury fall rates, which are used by CMS for quality measurement and public reporting,” researchers “found substantial underreporting on the specific Minimum Data Set (MDS) item (J1900C) used by NHC [Nursing Home Compare].”  Prachi Sanghav, Shengyuan Pan, Daryl Caudry, “Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare,” Health Services Research, p. 5.  2019;00:1-10. https://doi.org/10.1111/1475-6773.13247.  Only 57.5% of residents’ major injury falls that were identified in Medicare hospital admissions claims data were reported on residents’ assessment data.

Researchers analyzed 100% of major injury falls in hospital admissions claims data from the Medicare Provider Analysis and Review (MedPAR) for the period January 1, 2011 to September 30, 2015 (150,828 falls).  They compared these claims data to facilities’ self-reported MDS data for the same period, focusing on J1900C (major injury during current stay), “as the responses to this question for long-stay residents are used to create an NHC quality measure and are part of the star rating algorithm.”  Article 2.  Researchers found

  • Only 57.5% of the claims were reported on MDS.
  • More falls were reported on MDS for long-stay residents (62.9%) than for short-stay residents (47.2%).
  • More falls were reported on MDS for white residents (59.0%) than for nonwhite residents (46.4%).
  • Long-stay white residents had the highest reporting rate (64.5%), while short-stay nonwhite residents had the lowest reporting rate (37.4%). 4.

Researchers also found poor correlations between claims-based falls rates and quality measure star ratings and overall ratings.  At least 75% of the nursing facilities had a four- or five-star quality measure rating and half the facilities had four- and five-star overall ratings.  Id. 4-5, Table 4.

As a matter of policy, the researchers suggest that “claims-based measures may be useful supplements or replacements for the MDS-based patient safety indicator.”  Id. 6. 8.

“Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare” is available at https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.13247 and from the Center for Medicare Advocacy, on request.

January 30, 2020 – T. Edelman

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