Group to Assess Impact of Social Determinants of Health on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.

In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.

NQF-logoWith the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients may be especially and unfairly harmed by such programs.

The National Association of Urban Hospitals (NAUH) has long expressed concern about the lack of risk adjustment in new Medicare payment programs and has endorsed legislation to require Medicare to address this problem.

Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

Congressman Rallies Support for Medicare Readmissions Bill

Congressman James Renacci has put out a call to his fellow House members to support H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program Act.

The bill seeks to improve Medicare’s hospital readmissions reduction program, which penalizes hospitals that are deemed to have “too many” Medicare readmissions, but adding a risk adjustment component to reflect the additional challenges that some hospitals – like private safety-net hospitals – face because they serve low-income patients who often are more difficult to treat than the typical hospital patient.

US Capitol DomeIn a “Dear Colleague” letter, Representative Renacci invites his House colleagues to join him as a co-sponsor of the bill.

The National Association of Urban Hospitals (NAUH) has long called for such risk adjustment in the hospital readmissions reduction program, has endorsed the bill, and has worked to recruit co-sponsors for the measure.

See Mr. Renacci’s appeal to his House colleagues here.

NAUH Endorses Bill to Reform Controversial Medicare Program

The National Association of Urban Hospitals has written to Senators Joe Manchin (D-WV) and Roger Wicker (R-MS) endorsing their new legislation, the Hospital Readmissions Program Accuracy and Accountability Act.  The bill calls for adding risk adjustment to Medicare’s hospital readmissions reduction program – a change NAUH has long advocated.

NAUH LogoNAUH has long maintained that the program requires risk adjustment because so many of the people who turn to private safety-net hospitals for care have endured years of socio-economic challenges that, over time, lead to medical problems that are more difficult to treat.  A number of recent studies have confirmed this belief.

See NAUH’s endorsement letter here.

Medicare Risk Adjustment Methodology Questioned

Medicare should perform risk adjustment of payments to hospitals and insurers based on socioeconomic considerations or the overall health of populations rather than on the medical conditions of patients, according to a new study.

Analysts at the Dartmouth Atlas Project compared the current methodology, which adjusts risk, and therefore payments, based on the underlying medical condition of Medicare patients, to several other risk adjustment methodologies and found that socioeconomic considerations – that is, the poverty of the region in which patients live – and the overall health of regional populations is a better approach to payment risk adjustment.

iStock_000015640638XSmallRisk adjustment is used to determine how the federal government pays Medicare Advantage plans and how it penalizes hospitals for what are considered “excessive” Medicare readmissions.

The National Association of Urban Hospitals (NAUH) has long called for Medicare to risk-adjust its hospital readmissions reduction program based on socioeconomic factors and has, in the wake of several studies that question the program’s fairness, endorsed legislation to require such risk adjustment.

Learn more about the new study in the article “A population health approach to reducing observational intensity bias in health risk adjustment:  cross sectional analysis of insurance claims,” which has been published in the journal BMJ.  Find the article here.

Community Factors Influence Readmissions, Study Says

A new study reports that a variety of factors, including several linked to socio-economic status, account for 58 percent of the variation in the rate of Medicare hospital readmissions at the county level.

iStock_000001497717XSmallAmong those factors are low employment, living alone, inability to afford care, the supply of primary care providers and specialists, access to post-discharge nursing home care, and more.

The study found that

The evidence shows that after accounting for patient-risk factors (done by the risk- standardization of the publicly reported rates) and community socioeconomic factors (such as income and employment levels), as well as accounting for hospital characteristics and location, a substantial amount of the variation in readmission rates is explained by local health-system characteristics related to primary care access and the quality of nursing homes. These findings have significant implications on how health care leaders, payers, and policy makers should conceptualize the level of accountability for excess readmissions. The current readmission reduction program that aims to penalize hospitals whose readmissions are above a certain threshold may not be appropriate (Centers 2012). Instead, other payment methods such as those being tested in the Community-based Care Transitions Program (Community 2012), where community-based organizations receive a bundle payment to cover the costs of services required in the postacute care transition period, might be more effective.

It also concluded that

… hospital readmission rates might be more effectively reduced if community-based readmission reduction strategies are added to ongoing, hospital-focused improvement efforts.

This has long been the contention of the National Association of Urban Hospitals:  that social determinants of health make the kinds of low-income Medicare patients private safety-net hospitals serve more difficult to treat, contribute to higher readmission rates than the typical hospital, and need to be reflected in appropriate risk adjustment for Medicare’s hospital readmissions reduction program.

The study, from Health Research Services, is titled “Community Factors and Hospital Readmission Rates” and can be found here.

Bill Would Modify Medicare Readmissions Program

New legislation introduced in Congress would add a risk adjustment component to Medicare’s hospital readmissions reduction program.

Under H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, hospitals’ performance in preventing Medicare readmissions would be risk-adjusted for patients who are dually eligible for Medicare and Medicaid; for patients who are considered non-compliant; for patients whose readmission has been classified as based on psychosis or substance abuse; and for patients who have specific medical conditions.

US Capitol DomeHospitals found to have too many Medicare readmissions suffer financial penalties under the program.

The National Association of Urban Hospitals (NAUH) has long maintained that the program is unfair to private safety-net hospitals because it fails to reflect the more medically and socially challenging patients such hospitals serve and has advocated adding a risk adjustment component to the program.

Learn more about the bill from this news release from its sponsor, Rep. James Renacci (R-Ohio), or find the bill itself here.