NAM report identifies social risk factors that may influence Medicare measure performance

AHA News

The National Academy of Medicine (NAM) Jan. 12 released the first in a planned series of reports that will identify “social risk factors” affecting the health outcomes of Medicare beneficiaries and methods to account for these factors in Medicare payment programs like the Hospital Readmissions Reduction Program (HRRP).

The first report provides a “conceptual framework” for how social risk factors may influence health care use, outcomes and costs in Medicare payment and quality programs.

The NAM report identifies five social risk factors that are likely to influence health care outcomes and quality measures, based on a literature search. They are socioeconomic position; race, ethnicity and cultural context; gender; social relationships; and residential and community context.

“All other things being equal, the performance of a given health care system can undoubtedly be affected by the social composition of the population it serves,” says the report.

The report also identifies examples of relevant Medicare quality measures, including certain hospital admission, readmission and experience of care measures, among others.

The AHA and a growing number of policymakers contend that Medicare needs to account for socioeconomic and other social risk factors beyond hospitals’ control when measuring hospital quality in quality reporting and pay-for-performance programs. Take HRRP as an example. Patients are more likely to be readmitted if they cannot afford follow-up treatments or have limited access to access to resources like healthy foods or therapy that leads to better outcomes.

The Medicare Payment Advisory Commission recommended socioeconomic adjustments for the readmissions penalty program in 2013, and the National Quality Forum’s 2014 expert panel’s recommendations to adjust measures for sociodemographic factors received widespread support.  

“This important report provides evidence-based confirmation of what hospitals and many policymakers have long known – socioeconomic and other social risk factors matter greatly in measuring the quality of hospitals,” wrote Akin Demehin, an AHA senior associate director of policy, in a Jan. 12 AHASTAT blog post.

The Department of Health and Human Services asked the NAM to convene the committee, which will also identify best practices of high-performing hospitals, health plans and other providers that serve disproportionately higher shares of socioeconomically disadvantaged populations.

“Future work of the committee will address the question of whether a specific social factor could be incorporated into Medicare payment programs, the methods to do so, and data needs to accomplish the task,” the committee said.

The AHA supports the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R. 1343/S. 688, which would require the Centers for Medicare & Medicaid Services  to account for patient sociodemographic status when calculating the penalties. 

 

Topic: Quality and Patient Safety
Tag: readmissions

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