OIG Highlights OASIS Under Reporting of Falls with Major Injuries

New OIG Report notes that agencies failed to report over half of falls with major injury. On Sept. 5th, the Health and Human Services’ Office of the Inspector General (OIG) released the report, “Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients”.

The key takeaways from this report were that among Medicare home health patients hospitalized for falls with major injury:

  • 55% were not reported on OASIS assessments by home health agencies (HHAs) as required. The OIG voiced concerns that due to this high rate of non-reporting, Care Compare may not provide accurate information about the incidence of these falls.
  • Reporting of falls with major injuries was lower among for profit HHAs as compared to nonprofit and government-owned agencies.
  • 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.

 

OIG Recommendations to CMS

In conclusion, the OIG made four recommendations to CMS to which CMS concurred. These recommendations included that CMS should:

  • Take steps to ensure the completeness and accuracy of the HHA reported OASIS data used to calculate the falls with major injury quality measure.
  • Use data sources, in addition to OASIS assessments, to improve the accuracy of the quality measure related to falls with major injury.
  • Ensure that HHAs submit required OASIS assessments when their patients are hospitalized.
  • Explore whether improvements to the quality measure related to falls can also be used to improve the accuracy of other home health measures.

 

Take Away Actions for Home Health Agencies

This report highlights 2 issues agencies may have with OASIS data collection: inaccurate data and incomplete (missing) data. The report suggested, “CMS could also encourage State agencies to check for completion of assessments when home health patients are hospitalized as part of the survey process.”

This report serves as a call to action for home health agencies. Although CMS has not yet provided details on their response to the OIG report, agencies can use this report as a call to action to drive their increased efforts in supporting accurate and compete OASIS data collection.

Question: How is your agency investigating your OASIS accuracy and completeness and proactively preparing for the anticipated CMS actions related to the OIG report?

 
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