Home Health Agencies Fail to Report More than 50% of Falls Leading to Major Injuries, OIG Finds

McKnight’s Home Care | By Adam Healy
Home health agencies neglected to report 55% of falls leading to major injuries and hospitalizations on their Outcome Assessment Information Set (OASIS) assessments, according to a study conducted by the U.S. Office of Inspector General.
OIG analyzed hospital claims for Medicare home health patients and identified those that included a fall. This was compared to the home health provider’s OASIS assessments and its fall rate report on Care Compare. OASIS falls reporting was worse among young home health patients, along with those who identified as Hispanic, Black and Asian. Of 39,900 falls identified that resulted in major injury, 85% led to a bone fracture and 11% led to “head injury with altered consciousness,” according to the report.
For-profit home health agencies came up worse than other agencies in reporting Medicare home health patients’ falls. During the one-year period examined between 2020 and 2021, for-profit agencies failed to report 56% of falls. That compares to the failure to report falls among nonprofit agencies (52%) and government-run agencies (38%).
A major red flag was the lack of reporting about a hospitalization related to the fall on the OASIS assessment, OIG found. 
“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 report said.
Noncompliant OASIS reporting would lead to incomplete or misleading fall rate statistics on Care Compare, OIG noted.
“These patient assessments are used by CMS to monitor and provide public information about home health care quality,” said Ann Maxwell, deputy inspector general for evaluation and inspection, in the report. “Due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls.”
OIG found that that home health agencies with the lowest Care Compare major injury fall rates reported falls less often than agencies with higher Care Compare fall rates. This indicated “that Care Compare does not provide the public with accurate information about how often home health patients fell.”
OIG made four recommendations to the Centers for Medicare & Medicaid Services to remediate the issue of non-reporting. These recommendations included taking steps to ensure falls are reported in OASIS assessments and using other data sources to develop more accurate reporting measures. 
In a letter to OIG, CMS Administrator Chiquita Brooks-LaSure concurred with the inspector’s recommendations.
“CMS understands the importance of providing accurate quality information to home health agencies and the public,” Brooks-LaSure said. “CMS will explore opportunities to help promote the completeness and accuracy of the home health agency reported OASIS data used to calculate the falls with major injury quality measure, including additional OASIS outreach and educational opportunities.”