Assessing the Accuracy of Nursing Home Falls Reporting in MDS Assessments

In the Medicare and Medicaid programs, when a nursing home resident experiences a fall, the nursing home is required to report that fall, and the severity of any resulting injury, in a patient assessment. CMS then uses this information to determine, for each Medicare-certified nursing home, the percentage of residents experiencing falls resulting in major injury. This percentage is posted on CMS's Care Compare website to give consumers information about the relative performance of each nursing home. In this study, we will assess the accuracy of the patient assessment data used to calculate nursing home falls rates. Specifically, we will identify hospitalizations due to falls with major injury among Medicare enrollees receiving nursing home care using Medicare claims. In the first study, we will assess the extent to which those falls were reported by nursing homes in patient assessments. We will examine the characteristics of the people who did not have their falls reported. Finally, we will examine the characteristics of nursing homes that did not report falls among their residents. In the second product, we will provide additional details about the falls with major injury and hospitalization that we identify, which could include the amount of time spent in the hospital, the cost of the hospital stays to the Medicare program and enrollees, and outcomes.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
March 2024	Centers for Medicare and Medicaid Services	Assessing the Accuracy of Nursing Home Falls Reporting in MDS Assessments	Office of Evaluation and Inspections	OEI-05-24-00180; OEI-05-24-00181	2025