Who Pays for Patient Falls?

As of October 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer pay for patient falls. The CMS ruled that hospitals and health care providers will no longer be reimbursed for preventable Hospital Acquired Conditions (HAC), which means that the CMS will not pay to treat conditions that were not present upon the patient’s admission.  CMS includes “Patient Falls” as one of 10 Hospital‐Acquired Conditions that is high cost, high volume, or both, and can reasonably be prevented through the application of Evidence Based Guidelines.

As a result, it is now the hospital’s responsibility to pay for resulting patient injuries, or required treatments, from a fall in a hospital setting.

According to Medicare, the average payment for the treatment of a patient fall injury was $24,962. Based on this figure, it’s easy to see how patient falls and fall-related injuries could end up being a costly expense for hospitals. Especially with the United States experiencing significant growth in the senior population, hospital-acquired patient falls could end up costing hospitals hundreds of thousands of dollars each year.

Hospitals must now focus on fall assessment, protocols, and preventions in order to develop strategies and solutions to prevent patient falls and injuries.

Risk Factor Interventions

The CMS has made available to the public “evidence‐based guideline resources to assist users in the prevention of the CMS‐identified hospital‐acquired conditions.” These resources are exclusively available through the US government agency “National Guideline Clearing House.”

These Fall Interventions include:

   1. Assess patient fall risk using Morse, Hendrich II, or Johns Hopkins “tools”

   2. Establish universal falls interventions for all patients

   3. Add strict fall precautions for patients at risk

   4. Implement impaired mobility interventions

Assess patient fall risk	Use Morse, Hendrich II, or John Hopkins “tools” to determine fall risk
Establish universal falls interventions for all patients	Implement low beds that must achieve a low height between 8-10" Place hospital bed in the low position Familiarize the patient to the environment including the nurse call button Use sturdy handrails in patient bathrooms, room, and hall Use night light
Add strict fall precautions for patients at risk	Assist patients in the bathroom and offer hourly assistance A staff member must remain with the patient when assisted to the bathroom Perform hourly checks of patient Use a bed-exit alarm
Implement impaired mobility interventions	Patients should wear shoes or non-skid footwear Assist high-risk patients with transfers Use of patient's regular assistive device such as a walker or cane, or equipment recommended by physical therapy or occupational therapy Regularly scheduled assistance with toileting

Since almost 22% of patient falls are from the hospital bed, one of the first risk factor interventions a hospital should consider is the implementation of low hospital beds.

Guidelines recommend that all hospital beds are to be placed in the low position as a precaution for all patients. Though many traditional hospital beds have “low” settings, these settings do not compare to the low resting height of low hospital beds. Low hospital beds have the ability to go lower than traditional hospital beds to a height of 8-10” from the ground, which minimizes fall risks and injuries for all patients.

Many patient falls occur while entering and exiting the bed. This has been identified as a leading cause of bed falls, and can be minimized with the use of a low hospital bed, which eliminates the need to slide or jump from the bed onto the hard floor. Patients feel confident and secure closer to the ground in low hospital beds, which can reduce the occurrence of falls.

Low hospital beds like the CHG Spirit Select also provide an integrated bed-exit alarm and an underbed nightlight that support other intervention directives for patients with impaired mobility and patients at a general risk of falls.

Within 5 months of implementing low hospital beds with integrated bed-exit alarms, one large health care system reported a 9% falls rate reduction according to the Institute for Clinical Systems Improvement. With the proper strategies in place, hospitals can reduce not only patient falls, but the hospital’s out-of-pocket expense for treating these hospital acquired conditions.

Conclusion

Though CMS no longer reimburses hospitals for the treatment of patient falls, which has been a costly change for hospitals, this measure can act as an incentive to reduce fall rates. By incorporating fall reduction strategies and assessing patients throughout their stay at the hospital, hospitals and patients can benefit from a reduction in fall rates and an increase in patient safety.

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CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.


Sources:
Degelau, J., Belz, M., et al. (2012). Prevention of Falls (Acute Care). Institute for Clinical Systems Improvement. Prevention of Falls. Retrieved from http://bit.ly/Falls0412
National Guideline Clearinghouse. (2012). Prevention of falls (acute care). Health care protocol. Agency for Healthcare Research and Quality. Retrieved from http://guideline.gov/content.aspx?id=16005
Rosenthal, M. (2007). Non payment for Performance? Medicare's New Reimbursement Rule. The New England Journal of Medicine. 357 (16), p. 1573.