New Medicare PQRS Falls Assessment and Physical Therapy

As the majority of “baby boomers” enter retirement age, we are seeing more and more people that are eligible for our government’s Medicare benefits come to physical therapy for help with various pain complaints, joint stiffness, and other impairments. In fact, in 2012, Colorado had over 650,000 residents that partook in Medicare benefits, and it’s safe to say that the number continues to grow.1 As a provider that treats Medicare patients, it is important for us to comply with the various rules and regulations that are ever-evolving in order to provide the most efficient treatments for our patients and clinic alike. One of the most recent changes was the addition of a Fall Risk Assessment as one of the factors that we must address anytime we treat a person who uses Medicare benefits.

The new standard for addressing safety in adults over age 65 requires that a Fall Risk Assessment take place at least once per year. What this means for you, the patient, is that you will be asked about any history of falls in the past year. In this case, a fall is defined as, “a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force”.2 If you answer that you have had two or more falls in the past year, the next step involves checking your blood pressure and assessing your balance, as well as assessing your answers to a questionnaire called the Falls Efficacy Scale, which basically asks you to rate your confidence during certain activities.

If it is determined that you are at risk of falling based on our assessment as described, we then have to come up with a plan of care. The most important part is figuring out how we can best help you prevent any future falls! The Medicare guidelines write out that the plan of care must take the following things into consideration: vitamin D supplementation, balance, strength and gait training.3 The great thing about this is that, as physical therapists, we normally would be addressing balance, strength and gait as part of our standard of care, so there is nothing new required from us on this front. However, we will likely be referring you to your primary care physician to discuss vitamin D supplementation, if that is not already part of your medication regimen.

Hopefully you have not experienced any falls in the past year, and none of this would be applicable to you! However, we know that “life happens” and, unfortunately, falling can be part of life for a number of reasons. Please contact us today whether or not you have had a recent fall, to be evaluated by one of our skilled physical therapists as well as to find out what you can do to prevent a fall from occurring in the future.

  1. The Henry J. Kaiser Family Foundation. State Health Facts. Total Number of Medicare Beneficiaries. 2015. Available here: Accessed Mar 11, 2015.
  2. American Medical Association. Measure #154 Falls: Risk Assessment – National Quality Strategy Domain: Patient Safety. 2014. Available here:… Accessed Mar 12, 2015.
  3. American Medical Association. Measure #155 Falls: Plan of Care – National Quality Strategy Domain: Communication and Care Coordination. 2014. Available here:… Accessed Mar 1, 2015.