OIG: Failure to Post Home Health Falls Taints Care Compare Quality

September 11, 2023 - Inaccurate reporting of home healthcare falls may be tainting the quality of information shared via Care Compare, the online platform the Centers for Medicare and Medicaid Services intends to help consumers make healthcare access decisions, the HHS Office of Inspector General said in a recent report.

The report centered on fall rates, a major patient safety measure, among home healthcare providers. Overall, 55 percent of the Medicare claims included in the OIG analysis did not report falls to the Outcome Assessment Information Set (OASIS), which ultimately informs the data displayed on Care Compare.

Starting in 2019, CMS has required home health agencies to publicly report their major fall rates to OASIS. This specifically includes falls that resulted in hospitalization. Fall rates reported to OASIS then factor into major injury fall rates at HHS, which, starting in 2022, became a part of the Care Compare website’s quality measures, OIG said.

In theory, reporting on fall rates via Care Compare would arm healthcare consumers and their families with the information necessary to choose the best home health agency for their needs.

But that may not be happening because the data on Care Compare is faulty.

OIG looked at Medicare hospital claims for home health patients to get a sense of realistically how many falls happened during the study period. The agency then looked at whether those falls were reported in OASIS assessments, finding that more than half—55 percent—were not.

These findings raise serious questions about the validity of Care Compare information, OIG said.

For one thing, the home health agencies with the lowest Care Compare major injury fall rates were also the least likely to report a fall when they should have, OIG said. Conversely, agencies with higher Care Compare fall rates were more likely to report falls when they should have. OIG said this could mean that Care Compare is not an accurate tool for assessing at least the patient safety of a home health agency.

“Finally, 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 explained.

OIG also looked at the patient populations most likely to get missed in an OASIS fall report, noting racial health disparities in safety. It was more common for young home health patients and those who identified as Black, Hispanic, or Asian to have their falls go unreported compared to their older or White counterparts.

Fall reporting was also lower among for-profit home health agencies than nonprofit and government-owned agencies, OIG noted.

In response to these findings, OIG recommended CMS make some changes to how it requires home health agencies to report falls when the fall requires hospitalization. Additionally, OIG suggested that CMS work to ensure the completeness of OASIS falls data, find other data sources to supplement OASIS data about falls, and look at whether CMS can apply improvements to falls reporting to other home health agency quality reporting.

CMS concurred with all of those recommendations, OIG said.

This is not the first time OIG has found issues with the information displayed on Care Compare. In April 2023, OIG reported that 67 of 100 sampled nursing homes did not have a flag for one or more of its issues with health, fire safety, and emergency preparedness. The report indicated that the lack of reporting impedes consumers’ ability to make informed decisions about healthcare access.

Typically, CMS populates that quality information in part using assessments from state survey agencies, OIG explained. State survey agencies visit the nursing homes and complete a survey assessment about the healthcare quality, fire safety, and emergency preparedness of each nursing home. From there, CMS uploads that quality data onto Care Compare.

But according to the April OIG report, that second part of the process doesn’t always happen. CMS does not always include negative reports from the state survey agencies on the Nursing Home Care Compare website.

Findings from both OIG reports are concerning, considering the role CMS intends Care Compare to play in patient access to care. The websites are tailored for a consumer audience to help them assess their options for healthcare encounters they can schedule. These OIG reports may indicate needed improvements in how quality data is uploaded and represented on Care Compare.