It’s too early to tell what impact a broader definition of falls that have to be reported in skilled nursing facilities (SNFs) will have on quality scores, but experts in the nursing field tell Park Place Live the latest iteration of the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument User’s Manual is a head scratcher.

At issue is new language in the MDS that states building staff must now note falls that result from “overwhelming external force.” Alicia Cantinieri, managing director of clinical reimbursement & regulatory compliance, Zimmet Healthcare Services Group, said this means incidents that previously were considered accidents, not falls – like a resident bumping into a med cart – are now included in the facility’s prevalence of falls.

Falls like that have traditionally been excluded from MDS forms and did not factor into quality measure scoring.

She said there was no reason given for the change in reporting rules, but the new language could have a big impact on quality scoring. “We take lots of measures to prevent falls, the way we walk residents down the hall, for instance, but I am not sure how you plan for what used to be an accident. It is very odd. I mean what was not considered a fall on Sept. 30 is now considered a fall [since the new MDS language became active on Oct. 1],” Cantinieri said.

There is also the issue of new MDS definitions of what is considered a major or minor injury resulting from the broader requirements on falls reporting, she said.

The MDS before the new Oct. 1 version kicked in defined major injuries tied to a fall as all bone fractures but only closed head injuries with altered consciousness or subdural hematoma. The definition now is listed for more injuries and includes “but is not limited to” traumatic bone fractures, joint dislocation/subluxations, internal organ injuries, amputation, spinal cord injuries, head injuries, and crush injuries.

Cantinieri said the five words “but is not limited to” will likely lead to ambiguity on how CMS surveyors, for instance, determine the extent of the injuries given the time lag between an incident and a regular survey. “Our documentation is going to have to be pristine,” she said.

A lot is at stake given Quality Measures help determine Five-Star ratings, the SNF Quality Reporting Program, and eventually incentive payouts for the SNF Value-Based Purchasing Program.

A spokesperson for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said the trade group is working to help providers incorporate new changes in the MDS, such as those around falls, noting that “education will be key to understanding the updated definitions.” 

"As always, accurate reporting is important, and we encourage long term care providers to focus on education, monitoring and, in some cases, working with their EMR vendor to ensure alignment,” AHCA/NCAL said.

Comments or questions? Email Patrick Connole at pconnole@parkplacelive.com.