BIG Changes to the Falls with Major Injury QM: What Changed and Why it Matters

by | Sep 10, 2025 | 5-Star, Compliance, Falls, MDS, QAPI, Quality Measure, VBP

BIG Changes to the Falls with Major Injury QM: What Changed and Why it Matters

 

In the ever changing environment of quality reporting in healthcare, few metrics carry more weight than the Falls with Major Injury (FMI) measure. The Falls with Major Injury (FMI) Quality Measure (QM) is a key metric in the SNF Quality Reporting Program (QRP). With the release of the MDS 3.0 RAI Manual V1.20.1 effective 10/1/2025, CMS introduced a new definition of falls and of major injuries as they relate to falls that will reshape how providers assess, track, report, and prevent these adverse incidents. Backed by insights from the May 2025 Technical Expert Panel (TEP), this update marks a significant shift toward a more accurate, cross setting measurement of falls.

 

Why Falls with Major Injury Matter

Falls are among the most common adverse events in healthcare settings and especially common among long term care facilities. When a fall results in a major injury it can lead to hospitalization, disability or even death. For Skilled Nursing Facilities (SNFs), preventing falls—especially those resulting in major injury—is not just a clinical priority but a regulatory one. The Falls with Major Injury (FMI) Quality Measure (QM) serves as a benchmark for patient safety, influencing public reporting, reimbursement and quality improvement initiatives

 

What’s new in the October 2025 definition?

With the October 2025 update, Falls are defined as an unintentional change in position coming to rest on the ground, floor, or next lower surface or the result of an overwhelming external force (e.g. a being pushed by another resident). Falls include intercepted falls where the residents would have fallen if they had not caught themselves or not been intercepted by another person.

Fall related major injuries are more precisely defined to include:

    • Traumatic Bone fractures
    • Joint dislocations
    • Subluxations
    • Internal organ injuries
    • Amputations
    • Spinal cord injuries
    • Head injuries, and
    • Crush injuries

The manual also provides guidance in differentiating between traumatic fractures and pathological fractures to assist with accurate coding and ensure that pathological fractures are not incorrectly coded as fall related fractures.

The definition aligns with ICD-10 codes and external cause of injury codes, which will allow for the standardization across body systems and post-acute care settings.

 

TEP Recommendations: Data-Drive Overhaul

The May 2025 TEP brought together experts from across disciplines to address concerns related to underreporting and inconsistencies in the current Falls with Major Injury quality Measure. Key recommendations from the TPE include:

 

Integration of Claims Data

    • Dual- Source Reporting: MDS assessment data (J1900C) combined with claims- diagnosis reporting to more accurately capture FMI incidents
    • Expanded diagnosis code sets: The inclusion of traumatic fractures, joint dislocations and subluxations, head injuries (with or without loss of consciousness), and organ trauma.

 

Use of External Cause of Injury Codes

    • Encourage consistent use of 1CD 10 external cause codes to better identify falls across claims and care settings
    • Recognize variability in coding practices across providers and post-acute care settings

 

Refined Measure Exclusions

    • Exclude pathological fractures and other injuries that do not meet the definition of a major injury
    • Clarify the exclusion in the manual guidance to reduce the risk of overreporting

 

Key Implications for Providers

These changes represent a significant shift in how falls are tracked, reported, and addressed:

    • Improved accuracy: The integration of claims data aims to address concerns related to inconsistencies between the actual FMI incidents and those that are reported
    • Consistency Across Care Settings: Hospitals, SNFs, home health agencies and other post-acute care provider will be measured based on the same definitions
    • Enhanced Accountability for Patient Safety: Providers must refine documentation and coding practices to align the new definitions and standards.

 

Strategies to Prepare for the Changes and Improve Patient Safety Outcomes

  1. Provide Team Training: Everyone plays a role in assessing, tracking reporting and prevention of falls. Interdisciplinary team members must understand the implications of the new definition and manual guidance. In education sessions, include case examples illustrating what qualifies as a fall related major injury and strategies for improving documentation practices to reflect the new expanded scope of injuries
  2. Clarify Exclusions: The TEP placed an emphasis on excluding pathological fracture and injuries not meeting the threshold of major from the measure calculation. Partner with the facility medical director to clarify pathological versus traumatic fracture as appropriate. Clearly document the clinical rationale when determining the major injury is not met.
  3. Conduct Accuracy Audits: Conduct periodic audits of falls documentation and related MDS coding to validate alignment with the updated definitions. If discrepancies are identified provide staff with education on proper documentation and accurate coding.
  4. Strengthen Fall Prevention Programs: With the increase in the types of injuries now identified as major, there must be an increased emphasis placed on the overall prevention of falls. Consistent implementation of a robust fall prevention program that utilizes a QAPI driven approach to identify and address root causes of falls is a must. Implement resident centered individualized fall prevention approaches for residents identified at risk for falls. Focus on environmental changes that will improve patient safety and decrease fall risks.
  5. Monitor Your Facility’s FMI Quality Metric: The FMI QM is a publicly reported measure that has an impact on the facility’s Five Star Rating and may influence reimbursement under value-based purchasing. Understanding where the facility stands, tracking performance and benchmarking for improvement with this measure is critical. Use internal dashboards to track falls and outcomes. Benchmark against state and/or national averages and set goals for improvement.

 

 

Next Steps:

 

 

Written By:

 

 

Chrstine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC

Senior Consultant

Proactive LTC Consulting

 

 

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