Hospital, Nursing Home Data And Communication Gaps Underpin Oig Falls Report

A recently released report from a federal watchdog agency drew attention to nursing homes’ underreporting of resident falls involving major injury – but policymakers and providers should not overlook the data and communication gaps and discrepancies between nursing homes and hospitals that are at issue in the report’s findings.

That’s a message that several nursing home industry leaders have emphasized in the wake of the report, which was released in September by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).

The report analyzed data from July 1, 2022, to June 30, 2023. OIG compared hospital Medicare claims and nursing homes’ Minimum Data Set (MDS) assessments to determine that 42,864 Medicare-enrolled nursing home residents experienced a fall that led to major injury and hospitalization, and 1,911 of those residents died while hospitalized.

Nursing homes did not report 43% of those falls with major injury and hospitalization in MDS resident assessments, which they are required to do.

But the report’s overall data wasn’t surprising, Dr. Andrew McNamara, chief medical officer with Trilogy Health Services, told Skilled Nursing News. He believes the OIG was looking to add hospital claims data to help fill in missing pieces on falls.

“I don’t think [the report] was written trying to find error. The findings are just that [falls] are underreported,” he said.

Trilogy Health Services is based in Louisville, Kentucky, and operates 141 facilities in Indiana, Kentucky, Michigan, Ohio and Wisconsin.

Industry leaders have pushed back on the report. The American Health Care Association (AHCA), the nation’s largest nursing home provider association, is concerned the report is flawed, a spokesperson told SNN.

That spokesperson said AHCA’s misgivings are “primarily due to a lack of a root cause analysis of the coding concerns. It is not reasonable to expect nursing home MDS data and hospital claims to entirely match given the differing information, instructions, and timing, and there is no evidence that hospital claims are more accurate. Also, we hope policymakers are not assuming that coding discrepancies are made intentionally; completing the MDS is highly complex.”

Stacy Mandl, VP of health policy for LeadingAge, the nation’s largest association of nonprofit aging services providers, said it is possible that SNFs sent patients to hospitals and didn’t receive them back, leading to a mismatch in data.

“Importantly, if in fact the outcome is unknown, the fall would likely not be reported on the MDS,” Mandl said. “It may be informative in future studies to better understand what is or is not communicated to the nursing facility from the acute care hospital following an injurious fall, as well as the assumptions made by the hospital with regard to the resident (e.g., if the patient had comorbidities that lend to pathological fractures).”

Mandle added that residents could be transferred to a hospital for an unrelated reason, and it’s not clear how the OIG parsed out claims data for falls that occurred during hospitalization.

McNamara agreed, saying that sometimes providers will code a fall one way, but then the hospital codes the injury a different way.

“You suspect an injury, but you’re not sure what bucket it goes in,” he said. “It may take a while to get that data back [from the hospital]. The communication piece is sometimes a challenge between the hospital and the facility having accurate data.”

Improving communication to improve data

Fall prevention and response are high priorities for nursing home providers. Trilogy has been focusing on the role medications play in falls, working to reduce antipsychotic use, McNamara said. The company is also working with its therapy partner, Synchrony Rehab, on tools, technologies, and therapies that can mitigate risk.

That said, it is imperative that nursing homes code accurately when falls do occur as well as conduct timely assessments that inform the coding, said Mandl. Sharing that information in real time when a patient transfers to a hospital will improve care coordination and patient outcomes.

“To that end, the ability to exchange health information in an electronic, interoperable manner can serve to promote timely, coordinated, high quality health care delivery,” she said. “Communication between SNFs and hospitals is also important given that individuals receiving care in a SNF may have health conditions that are complex, making them especially vulnerable during transitions in care.”

Technology should help bridge the gap between hospitals and nursing homes, said McNamara. Predictive analytics tools enable providers to look at a patient’s chart and see codes that can indicate a fall risk. Having access to the full electronic health record allows providers and hospitals to better coordinate care, he said.

“You’ll be able to build data sets, whether they’re your own or others – potentially – that you can [use to] evaluate how you’re doing against certain known risk factors,” he said.

Indeed, the OIG falls report is just the latest reminder of how reporting requirements for nursing homes could – and should – be improved, said AHCA Senior Vice President of Quality, Regulatory and Clinical Services Holly Harmon.

“Nursing homes are committed to reducing and reporting falls, a common risk factor for our residents given their age and health conditions,” she said. “One way regulators and policymakers can assist in this effort is by streamlining the reporting requirements for providers. By modernizing reporting processes for providers and focusing on the metrics that meaningfully measure quality, CMS can help improve the use of such data, and we hope to work with them on this effort.”

AHCA has created educational content on MDS reporting, because while preventing falls is important, the association said, ensuring quality data from reporting will better align results. McNamara said that this kind of education around how facilities should be coding falls and injuries can go a long way to improving communication between hospitals and providers.

The post Hospital, Nursing Home Data and Communication Gaps Underpin OIG Falls Report appeared first on Skilled Nursing News.