Executive Summary: New research plus web-based technology provides an innovative, comprehensive and reimbursable way to easily implement a robust fall risk program in any clinical setting without disrupting normal patient workflow. This program enables many clinics to add six or seven figure revenue with no capital outlay.
As healthcare providers, we have a responsibility to ensure the safety and well-being of our patients. Fall prevention is a particularly critical issue for healthcare providers working with older adults. The CDC, following the American Geriatric Society’s clinical practice guidelines, emphasizes the importance of evaluating every senior’s fall risk. In addition, Medicare’s MIPS Measure #318 explicitly requires screening all patients aged 65 and above for future fall risk as a best practice.
The CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) toolkit has been widely adopted as a fall risk screening tool and has had a positive impact on fall prevention efforts. However, recent research suggests that STEADI may not go far enough in identifying individuals at risk for future falls. Researchers have found that incorporating multiple physical performance tests – beyond what is contained in the STEADI protocol – offers a more accurate and reliable assessment of fall risk.
Research Review
A systematic review and meta-analysis conducted by Lusardi et al. (2017)1 examined over 2,200 fall risk studies and 12,700 population norm studies to determine the most clinically useful assessment tools for predicting falls. Lusardi found that, “Performance-based measures demonstrated a stronger ability to predict future falls than either medical history questions or self-report measures.”
Building upon Lusardi’s work, Parcetich et al. (2022)2 compared the predictive accuracy of the STEADI toolkit to the APTA-SR/3, a fall risk assessment tool based on Lusardi’s findings. The study found that the APTA-SR/3 had a significantly higher Positive Likelihood Ratio (2.35) compared to the STEADI (1.57), indicating superior predictive quality and accuracy.
In terms of reliability, Nithman et al. (2019)3 discovered that the STEADI toolkit demonstrated high false negative rates, meaning that many individuals who were categorized as low risk still experienced falls in the following 12 months. That study also emphasized the importance of conducting multiple performance-based outcome measures for a comprehensive fall risk assessment.
Limitations of STEADI
While STEADI offers a straightforward process for fall-risk assessment, it requires significant clinical overhead to manually synthesize the results, determine the appropriate next steps and develop a plan of care. Basic fall risk can be evaluated during an annual wellness visit, but as the research indicates, one-dimensional testing is likely to miss a meaningful number of at-risk individuals. Providers could choose to schedule a follow-up visit for more Physical Performance testing which is reimbursable under CPT code 97750. However, determining which tests to use and how to synthesize the outcomes requires work beyond those reimbursable units. Given the overhead and questionable profitability, it’s easy to understand why clinicians may shy away from implementing a truly robust fall risk program.
A More Comprehensive Approach
The combined findings from Lusardi, Nithman and Parcetich present a compelling, evidence-based rationale for moving beyond STEADI and implementing a far more robust fall-risk assessment. Lusardi, et.al. specifically cite the power of combining Physical Performance tests with simple medical history questions and two self-report measures. Their paper proposed a statistical model for combining all of those data points into one meaningful value, concurrently identifying more at-risk individuals and highlighting their specific deficiencies.
Leveraging Technology for a New Solution
In most clinical settings, every aspect of patient care is facilitated through web-based technology. EMRs are standard – if varied – and providers count on the features embedded in their EMR to help them advance the health and wellness of their patients. A robust fall-risk assessment should be a common attribute in any EMR system and available to every clinician who cares for seniors and others at risk. However, current offerings are scant and mirror the clinical and operational limitations of the STEADI program, along with its problem of false negative findings.
In contrast, webFCE offers a comprehensive, evidence-based software solution – the webFCE Fall Risk Assessment (FRA). Built on the findings of Lusardi, et. al, the webFCE FRA consists of up to 12 evaluative tools that calculate an individual’s risk and probability of falling, taking into account a wide range of factors for a more holistic assessment. The web-based software is powered by a mathematical and statistical model that automatically compiles all of the evaluative results into a straightforward fall-risk assessment, easily understood by patients. In addition, the software generates detailed reports and personalized care plans, streamlining the assessment process and ensuring consistent, evidence-based fall prevention strategies. Adding to its clinical advantages, the webFCE FRA is designed to integrate smoothly into existing EMR systems and clinical workflows, making it a practical solution for busy healthcare practices. Plus, the FRA is fully reimbursable using CPT code 97750 for Physical Performance Testing, making it a financially viable option for practices of all sizes.
Conclusion
The STEADI toolkit has played a vital and important role in fall prevention. As a broad initiative, it has likely saved lives and mitigated health care expenditures in vulnerable populations. However, awareness and a limited risk evaluation will not yield significant gains in fall prevention. Only a deep, multifactorial approach will identify the full range of those at risk, and providers must be able to offer that comprehensive approach easily and efficiently. A robust clinical initiative can’t be implemented without a keen eye on profitability, and any solution must include seamless EMR integration and negligible capital investment.
The right fall risk assessment program can be transformative – and profitable. At webFCE, we look forward to accelerating your opportunities in fall prevention. Please contact us with questions or comments – we look forward to connecting at AAOE 2024 Annual Conference in Chicago at Booth #1125.
REFERENCES
- Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Determining risk of falls in community dwelling older adults: a systematic review and meta-analysis using posttest probability. Journal of geriatric physical therapy. 2017 Jan 1;40(1):1-36.
- Parcetich Jr KM, Miner DG, Paul A, Wildman L. Utility of performance-based outcome measures (PBOMs) used in fall risk assessment tools for older adults. Dialogues in Health. 2022 Dec 1;1:100043.
- Nithman RW, Vincenzo JL. How steady is the STEADI? Inferential analysis of the CDC fall risk toolkit. Archives of gerontology and geriatrics. 2019 Jul 1;83:185-94.