CMS released a new training focused on the latest information for the respecification of the Falls with Major Injury Quality Measure
The Centers for Medicare & Medicaid Services (CMS) has released a new Web-Based Training focused on the latest information for the respecification of the Falls with Major Injury Quality Measure across Post-Acute Care settings. The training provides an overview of both the legacy and respecified FMI measure methodologies, outlines how CMS is now incorporating both assessment data and claims/encounter data into measure calculations, and reviews important updates to PAC data collection guidance related to falls and injury reporting. This educational resource offers valuable insight into CMS’s evolving approach to quality measurement, outcome validation, and cross-setting data integration. CMS has made the web-based training available through the SNF Quality Reporting Program Training webpage. The direct training link is also available here: CMS Web-Based Training: Falls with Major Injury Quality Measure Respecification
What Nursing Homes Need to Know
Falls remain a significant safety concern for older adults and a key focus area for quality measurement. CMS notes that approximately 20% to 30% of adults age 65 and older experience one or more falls each year, and falls are associated with injury, fractures, decreased functioning, reduced quality of life, and substantial health care costs. This respecification represents a significant shift in how fall-related outcomes may be identified, validated, and publicly reported across post-acute and long-term care settings.
Why the Change Matters
Historically, the FMI measure relied primarily on MDS assessment coding, specifically MDS items J1800 and J1900C, to identify falls resulting in major injury. However, recent research and findings from the Office of Inspector General (OIG) identified significant underreporting of these events within assessment data alone. CMS-supported research found that only 57.5% of claims-identified falls with major injury were reported in MDS assessment data, raising concerns that assessment data alone may undercount these events.
For SNFs, the respecified measure uses MDS assessment data and Medicare Fee-for-Service claims data to identify falls with major injury during the SNF stay. As a result, CMS moved forward with respecification efforts to improve accuracy, cross-setting consistency, and transparency in quality reporting.
Key Changes in the Respecified Measure
The updated FMI measure incorporates data sources beyond the MDS to identify falls with major injury, including:
• Medicare Fee-for-Service claims
• Medicare encounter data
• ICD-10 and external cause codes
CMS has also broadened the definition of “major injury” to include but not limited to conditions such as:
• Traumatic bone fractures
• Joint dislocations or subluxations
• Head injuries
• Spinal cord injuries
• Internal organ injuries
• Crush injuries
• Amputations
This respecification reinforces an important reality that quality measures are no longer dependent solely on assessment coding. CMS is increasingly leveraging claims-based validation methodologies to identify discrepancies between documented care events and submitted assessment data.
For interdisciplinary teams, this elevates the importance of:
• Accurate fall investigation documentation
• Consistent physician and hospital communication
• ICD-10 coding awareness
• Timely MDS completion and review
• Cross-department collaboration between nursing, therapy, billing, and clinical reimbursement teams
This makes post-fall follow-up especially important. Facilities should ensure that fall investigations, progress notes, transfer documentation, hospital return records, diagnosis information, and MDS coding are reviewed together so the resident’s record tells a complete and consistent story.
Facilities should anticipate increased scrutiny regarding:
• Fall root cause analysis
• Injury severity documentation
• Transfer documentation
• Coding alignment between hospital claims and facility records
The FMI respecification reflects CMS’s broader movement toward data integration, outcome transparency, and claims-supported quality validation. As quality programs continue evolving, organizations that prioritize documentation integrity and interdisciplinary communication will be better positioned for regulatory compliance, public reporting accuracy, and quality performance outcomes.
As quality reporting expectations continue to evolve, proactive clinical review, documentation oversight, and interdisciplinary communication are more important than ever. Polaris Group partners with providers to strengthen fall investigation processes, improve documentation integrity, and support accurate quality measure reporting.
