CMS's FY 2027 inpatient payment rule takes effect on October 1, 2026. One provision changes how the public will see every hospital's fall record. The rule makes the falls with injury eCQM mandatory. Then it moves each hospital's results onto Care Compare and Hospital Star Ratings.
The Hospital Harm – Falls with Injury eCQM is a CMS electronic clinical quality measure that tracks inpatient falls causing moderate or major injury. It counts adult hospitalizations with at least one injurious fall, relative to total inpatient days. Injuries present on admission are excluded, and results are risk-adjusted.
This post covers the reporting timeline, how the measure differs from PSI-08, what a high rate costs, and what actually lowers it.
Key Takeaway: CMS's FY 2027 rule makes the Hospital Harm – Falls with Injury eCQM mandatory starting with CY 2028 reporting. Results go public on the Provider Data Catalog first, then on Care Compare and Hospital Star Ratings. Reporting is voluntary today, so hospitals have about 15 months to lower their rate before mandatory reporting begins. Prevention technology that acts before a patient leaves the bed, like VirtuSense's VSTOne, targets the exact events this measure counts.
The falls with injury eCQM is CMS's electronic measure of inpatient falls that cause moderate or major injury. Reporting is voluntary in 2026 and becomes mandatory with the CY 2028 reporting period.
An eCQM, or electronic clinical quality measure, is calculated directly from EHR data. It doesn't rely on billing claims or manual chart review. That makes it harder for injurious falls to go uncounted.
The measure counts two levels of injury:
Moderate injuries matter more than many teams expect. According to AHRQ's Network of Patient Safety Databases, cited in the CMS measure specification, 41.8% of reported falls caused moderate injuries.
Here is the timeline hospitals need to plan around:
Sources: CMS FY 2027 IPPS final rule fact sheet; CMS TEAM quality measures.
PSI-08 counts only in-hospital falls that result in a hip fracture, using claims data. The falls with injury eCQM counts any fall with moderate or major injury, using EHR data.
That difference is large. A hospital can have a clean PSI-08 record and still have many lacerations, dislocations, and head injuries from falls. Those events never touched its HAC score. Under the new measure, every one of them counts.
PSI-08 feeds the PSI-90 composite used in CMS's HAC Reduction Program. (For that background, see our post on what CMS's HAC penalties mean for hospital fall prevention.) CMS is now moving toward Hospital Harm eCQMs. In the TEAM payment model, PSI-90 drops out after performance year 1. Starting in 2027, Hospital Harm – Falls with Injury is one of the patient safety measures that replace it.
A high rate doesn't trigger an IQR penalty on its own. The exposure comes from public reporting, Star Ratings, and, for TEAM hospitals, payment reconciliation.
The details matter here. The Hospital Inpatient Quality Reporting (IQR) Program is pay-for-reporting. According to CMS, hospitals that don't meet IQR requirements lose one-fourth of their annual payment update. Reporting the measure keeps a hospital compliant. Performing well on it is a separate question.
Performance carries three kinds of risk:
The events themselves are costly. A 2023 study in JAMA Health Forum by Dykes and colleagues found the average inpatient fall cost $62,521. AHRQ estimates that 700,000 to 1,000,000 people fall in U.S. hospitals every year. Falls were also the most frequently reported sentinel event to The Joint Commission in 2024, making up 49% of all reports.
The rate only drops when falls are prevented. That means reaching the patient before an unassisted exit, not responding faster after a fall.
Five steps give hospitals the best chance to improve during the voluntary window:
Common fall prevention approaches compare this way:
VirtuSense's VSTOne is an ambient vision AI platform that uses LiDAR and computer vision to monitor patients around the clock. It predicts unassisted bed and chair exits about 31 to 65 seconds before they happen. All processing happens on the device, so no patient data leaves the room. Patients don't wear anything, and no pressure pads are needed.
That early warning is what matters for this measure. Every exit caught before it happens is a potential injury fall that never enters the numerator. VSTOne also monitors pressure injury risk from the same sensor, which fits CMS's broader move toward Hospital Harm measures. Health systems using VSTOne have documented strong returns. Emory Healthcare reported a 5.5x ROI, and Northwell Health reported a 4x ROI. (Here's why one platform for falls and pressure injuries matters.)
What is the Hospital Harm – Falls with Injury eCQM?
It is a CMS electronic clinical quality measure that tracks inpatient falls resulting in moderate or major injury among patients 18 and older. It is calculated from EHR data, excludes injuries present on admission, and is risk-adjusted. A lower rate means better performance.
When is the falls with injury eCQM mandatory?
Under CMS's FY 2027 IPPS final rule, effective October 1, 2026, the measure becomes mandatory starting with the CY 2028 reporting period. Reporting is voluntary before then. CMS will publish results on the Provider Data Catalog first, then on Care Compare and Hospital Star Ratings.
How is the falls with injury eCQM different from PSI-08?
PSI-08 is a claims-based indicator limited to in-hospital falls that cause a hip fracture. The falls with injury eCQM uses EHR data and counts any fall with moderate or major injury. That includes lacerations, dislocations, fractures, and head injuries, so it captures far more harmful falls.
How can hospitals lower their falls with injury rate?
Preventing unassisted bed and chair exits has the biggest impact, because the measure counts only falls that actually happen. Many hospitals pair evidence-based fall protocols with predictive monitoring. VirtuSense's VSTOne, for example, uses edge AI to flag exit intent 31 to 65 seconds early, with no video leaving the room.
The falls with injury eCQM will soon be more than an internal quality metric. It will be a public score that patients, payers, and boards can look up. The voluntary reporting window is the lowest-cost time to improve, because every prevented injury fall now improves the baseline hospitals carry into mandatory reporting. Hospitals that move from reacting to falls to predicting them will be in the strongest position when results go public.
See how VSTOne helps lower your falls with injury rate before it goes public → Request a demo