A five-year study funded by the National Institutes of Health and the Patient-Centered Outcomes Research Institute aims to identify "the most effective combination of falls-prevention strategies to fit the needs of different individuals and different healthcare systems."
Albert Wu, MD |
An upcoming federal research project to prevent falls in seniors 75 and older may seem to have little relevance for hospital and physician leaders. But the impact its findings may have on hospital costs and reimbursement from payers is potentially enormous.
"The reason the industry should be interested in this study is that very soon, if not already, you will be accountable for the care of a defined population of patients, not just those who fall while in the hospital," says Albert Wu, MD, who directs the Center for Health Services and Outcomes Research at Johns Hopkins Bloomberg School of Public Health.
Announced last month by the National Institutes of Health and the Patient-Centered Outcomes Research Institute, is described as the first "large-scale study to identify the most effective combination of falls prevention strategies to fit the needs of different individuals and different health care systems."
Treatment of falls in older adults cost the U.S. healthcare system $30 billion in direct medical costs, in 2010 according to the CDC. And costs increase rapidly as people age because their injuries and their complications become tougher to treat.
Rewards for quality of care provided by doctors and hospitals in accountable care organizations means that "if your patients do badly, that's on your watch. The way things are going is that payment systems will drive [providers] to be more responsible for populations of people rather than one patient at a time.
The $30 million project, funded by the NIH and PCORI, is expected to take five years to complete, but Wu says preliminary results may come as early as 2017. Pilot program enrollment will begin in October.
"We definitely will have an impact on people after their discharge from hospitals in terms of their fall risk," says overall director of the 10-region project, Nancy Latham, PhD, a research assistant professor in the Health and Disability Research Institute at the Boston University School of Public Health.
The trial will randomize 6,000 patients recruited from physicians' offices to either typical care or to an intensive falls prevention intervention. The intervention includes exams for vision, balance, hearing, medication management, exercise, weight bearing and home fall risks.
Enabling seniors to maintain muscle strength could mean they are less likely to fall while hospitalized, and may recover from their hospitalization illness faster, Wu says.
Finding strategies to prevent falls in frail seniors will reward hospitals by reducing admissions for patients who have fallen, and therefore potentially reducing readmissions, says Wu, the principal investigator for the Baltimore study site.
Fall reduction would also have an impact on Medicare spending per beneficiary (MSPB) rates and 30-day mortality rates, since seniors who fall and require lengthy recovery often develop costly complications such as pneumonia, which can be lethal.
Both the MSPB (efficiency) rates and 30-day mortality rates are factored into hospitals' value based purchasing program algorithm, which carries as much as a 2% incentive payment.
Falls within hospitals are considered a major adverse events. Medicare will not pay for care required to treat consequences of falls.
The study will recruit 80 physician practices, half of which will be randomized to enroll more than 3,000 patients into a control arm and the other half to enroll 3,000 patients to an intervention arm. The patients will give their consent to participate.
Those in the intervention arm will receive monitoring and consultations from a falls risk manager, who is a healthcare worker trained in prevention strategies known to reduce falls.
Those in the control arm will receive what is the current standard of care, which is mainly just information about how to avoid a fall.
"The intervention arm will give people what is recommended to prevent falls, but what very few primary care doctors, including me, consistently do," Wu says.
Latham says that specific programs patients in the interventional arm will receive depend on a complex algorithm, but is based on evidence. For example, studies that show falls are reduced in patients who engage in regular exercise programs such as tai chi. Occupational and physical therapists, whose services are covered by Medicare, will come to patients' homes if the patients have reduced mobility.
"The gap has been to really get health systems to adopt these interventions and put them into practice. There has been poor uptake.
"We know that under perfect circumstances, these programs can work to reduce falls. With this study, we want to see, can we make the healthcare system work? Can falls risk managers—who I see as a kind of traffic cop to help people navigate through the healthcare system to get services they need—help reduce falls."