Falls With Major Injury: What SNFs Need to Know About the Respecified Measure
The Falls with Major Injury (FMI) measure is changing, and the change goes beyond a new calculation.
CMS has respecified the measure as a hybrid measure, combining information from MDS assessments with claims and encounter data.
For skilled nursing facilities, that means fall-related documentation and coding remain important, but the measure will no longer rely on assessment data alone to identify major injury events.
What is changing?
Under the respecified measure, CMS will use MDS assessment data along with claims and encounter data from hospital, emergency department and observation stays.
The MDS continues to play an important role. Items J1800 and J1900 are used in identifying falls and the number of falls reported on the assessment.
Claims data are then used to improve the identification of falls that resulted in major injury.
CMS defines the respecified measure as a hybrid measure because it incorporates both assessment and claims data.
Why does the change matter?
The change is intended to address limitations in the existing measure, including the potential for falls and injuries to be missed when relying on assessment data alone.
For SNFs, that makes accurate assessment coding and documentation even more important.
A fall that results in a hospital or emergency department visit may generate information outside the SNF's MDS record that can ultimately become part of the measure calculation.
What should facilities review?
Now is a good time to look at how your organization handles fall documentation from the initial incident through follow-up care.
Ask whether the clinical record clearly identifies:
Whether a fall occurred
The circumstances surrounding the fall
The resident's condition and injuries following the event
Whether the resident was transferred to another setting for evaluation or treatment
The clinical findings that support the MDS coding
The interdisciplinary team should also understand how information from outside the facility can intersect with the MDS record.
This is more than an MDS issue
The respecified FMI measure highlights an important point about quality measurement: information used to calculate a measure may come from more than one source.
Nursing, MDS, rehabilitation and other members of the care team all have a role in creating an accurate clinical record.
CMS has released technical specifications for the respecified measure as well as training addressing the changes. Facilities should review the updated resources and make sure staff understand any changes to fall and injury documentation and coding requirements.
The measure may be changing, but the underlying expectation remains familiar: accurate clinical information matters.
