How to Implement the Hospital Harm Falls with Injury eCQM

If you know Medisolv, you know we can't wait to dive into new measures, even when they're still in draft form! The latest addition to our lineup is the Hospital Harm – Falls with Injury (HH-FI) eCQM, which was finalized in the 2025 IPPS Final Rule. This brings the total count of Hospital Harm measures to seven. Clearly, Hospital Harm is a top priority for CMS, and it should be for you, too. The good news? We're here to help you get started!

The HH-FI eCQM is set to launch as a voluntary measure in 2026 and in 2027 will be required as a part of CMS’s new TEAM Model. In this new model, your performance on Quality measures will be linked to your payment. Even more reason to start preparing now.

To help you beat the clock, we’ve assembled this complete HH-FI-for-beginners guide. We’ll walk you through the “why” behind the measure, what patient populations you need to track, and how to capture the relevant data in your workflows. Let’s dive in.

[Editor’s Note: As always, be sure to review the measure's official specifications. And for a full schedule of your upcoming Hospital Harm requirements, be sure to check out our blog on the 2025 IPPS Final Rule.]

What does the Falls with Injury eCQM measure?

HH-FI assesses the number of inpatient hospitalizations where at least one fall with a major or moderate injury occurred among the total qualifying patients 18 years of age and older.

This is an inverse measure, so the lower your rate, the better.

Calculation: The measure is calculated by dividing the total number of falls with injury by the total number of eligible hospital days and multiplying by 1000. The data is risk-adjusted to account for factors that may affect fall rates, such as certain medications and BMI (more on that later!).

Why is CMS adding the Falls with Injury eCQM now?

As I mentioned, CMS is all about improving patient safety, and this new measure fits right into that mission. The measure aims to reduce adverse events in hospitals by shining a spotlight on fall rates and encouraging better fall prevention practices.

Some of you may be familiar with the Claims measure PSI 09: Falls with Injury. This new measure is similar. It’s pretty clear (to us at least) that CMS is building out these Hospital Harm eCQMs to eventually replace the PSI measures.

Patient falls are among the most common incidents reported in hospitals. They can increase length of stay and costs, and are considered a Serious Reportable Event. Falls can result in injuries ranging from minor abrasions or bruising to death. Major injuries have the biggest impact on patient outcomes, but data shows 41.8% of falls resulted in moderate injuries such as skin tear, avulsion, hematoma, significant bruising, dislocations, and lacerations requiring suturing.

This measure offers a standardized way to track falls, with the goal of helping hospitals use the data to reduce the number of falls that result in injuries. By focusing on falls with major and moderate injuries, healthcare facilities can fine-tune their monitoring and interventions to better protect patients who are at higher risk.

Think of it as a friendly push to review your fall prevention plans, put in place better fall prevention plans, and make your interventions fit each patient's needs.

Falls with Injury eCQM Populations

So how does a patient make their way into the HH-FI measure population? Let’s break it down.

Initial Patient Population

Layman’s description:

The Initial Population (IP) for the measure includes all patients 18 and over with an inpatient hospitalization that ends during the measurement period and a length of stay less than or equal to 120 days.

Simplified logic:

• Inpatient Encounter
• Discharged during the measurement period
• >18 years of age
• LOS < 120 days

Workflow & Mapping Requirements:

Denominator

Layman’s description:

The denominator is the same as the IP.

Denominator Exclusions

Layman’s description:

HH-FI accounts for the fact that some of your patients will have a fall diagnosis when they arrive at your hospital and excludes those patients.

Simplified logic:

• Fall diagnosis
• Present on Admission (POA) = Yes or Clinically Undetermined

Workflow:

Numerator

Laymen’s description:

Inpatient hospitalizations where the patient has a fall that results in a major or moderate injury during the encounter. The diagnosis of a major or moderate injury must not be present on admission.

Simplified logic:

• Adverse Fall Event / Inpatient Fall Diagnosis
•  Moderate or Major Injury
• Present on Admission = Not Present on Admission or Documentation Insufficient to Determine or NULL

Workflow:

Measure Observations: (this is the tricky part)

Once the measure populations are identified, the logic calculates two “measure observations.” This helps you figure out the rate of falls with injuries (per 1,000 patient days) and track the total hospital days and total falls with injuries.

• Observation 1 = Total number of hospital days for all qualifying patients minus exclusions. This just means that all hospital days for every qualifying patient will be added up EXCEPT those patients who had a fall diagnosis that was present on admission.
• Observation 2 = Total number of numerator cases (number of patients with an inpatient fall with injury). This is the total number of patients who had a fall with injury in the hospital, excluding those patients who had a fall diagnosis that was present on admission.

Hint: You want to make that you can track all of the populations included in this measure, including both observations AND the calculated rate per 1000 patient days. Otherwise, the information won’t be that helpful to you (or you’ll have to do a lot of math!).

Risk Adjustment

Laymen’s description:

CMS includes risk variable data elements in the measure’s specification that can put patients at a higher risk for falls with injury. After submission, the risk variables will be used to adjust your results to account for the number of higher risk patients in your measure population. Be sure to capture and submit these variables in your QRDA file. CMS will handle the adjustment calculations for you. Note…this measure requires ALL encounter diagnoses be submitted in the file (that’s a lot of data!).

Simplified logic:

• Medications active on admission: — anticoagulants — antidepressants — antihypertensives — central nervous system depressant medications — diuretics — opioids
• Anticoagulant medications administered during the hospitalization
• Diagnoses present on admission, which may increase the risk for a fall with injury: abnormal weight loss or malnutrition — coagulation disorders — delirium, dementia, or other psychosis — depression — epilepsy — leukemia or lymphoma — liver disease (moderate to severe) — malignant bone disease — neurologic movement and related disorders — obesity — osteoporosis — peripheral neuropathy — stroke — suicide attempt
• BMI
• All encounter diagnoses with rank (e.g., 1, 2, 3) and Present on Admission (POA) indicators

Workflow: (yup, Risk Variables require mapping too)

Tips for Getting Started with the Falls with Injury eCQM

Schedule a time to talk to Medisolv. The HH-FI eCQM is available soon in our ENCOR for Electronic Hospital Measures software, so you can be up and running on the measure in record time. Click here to send us a message.