Top Healthcare Quality Issues for 2015, Part 1

Cheryl Clark, January 6, 2015

For starters, low SES patients have more difficulty filling necessary prescriptions and scheduling a physician's visit following hospital discharge—factors that aren't under the hospital's control—and hospitals shouldn't be penalized because of it.

Even a top official for the National Quality Forum, Helen R. Burstin, MD, now agrees, writing with two others in a recent JAMA Viewpoint that "this policy of not including risk adjustment, adopted by [CMS] and others, potentially results in unfair comparisons among clinicians, hospitals, and other healthcare organizations."

But CMS has refused to relent. In its Aug. 22 final Inpatient Prospective Payment rule, the agency said "we continue to believe that the same care protocols and processes that are successful in caring for non-low-SES patient populations may also be successful in caring for low-SES patient populations."

But CMS may soon be forced to give in. The NQF board in July voted to amend its policy against sociodemographic risk adjustment to allow a "robust trial period" to see if a new algorithm is warranted. But rather than adopt an adjustment factor for all quality measures, the NQF may go for a "nuanced approach" in which some measures will be designated appropriate for an SES adjustment, and some won't.

Additionally, two Congressional bills, S. 2501 and H.R. 4188, would require CMS to include an adjustment factor in its readmission algorithm

"We can't continue to ignore the influence of sociodemographic factors on the measures we use for quality improvement [because] abundant research shows that poverty, lack of family support, language barriers, and other sociodemographic challenges make a difference in health care outcomes" says Bruce Siegel, MD, president and CEO of America's Essential Hospitals.

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