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NQF: Keep Social Risk Factors Out of Most CMS Hospital Readmission Measures

By Tinker Ready  
   August 03, 2017

The debate continues over whether hospitals that treat a lot of low-income patients should get a break on readmissions penalties levied by Medicare.

Intuitively, it makes sense. Using readmissions as a measure of high quality care means that readmissions measures should be adjusted for hospitals that treat sicker patients.

Data shows that some social factors, such as the trappings of poverty, can make patients sicker.

So, should hospitals that treat a lot of low-income patients with sub-standard housing and limited access to healthful food get a break on readmission penalties levied by Medicare?

It is a raging debate in health policy world. The latest development comes from the National Quality Forum, a national clearinghouse for quality measures. The group has declined to endorse adding social risk factors to most of the Centers for Medicare & Medicaid Services readmissions measures.

The report puts it this way:

"At this time, the CSAC (Consensus Standards Approval Committee) supports continued endorsement of the hospital readmission measures without SDS (sociodemographic.) adjustment based on available measures and risk adjustors."

The next sentence is a bit clearer: "The CSAC recognizes the complexity of the issue and that it is not resolved."

It is far from resolved, some would say.

Medicare's readmission measures adjust for age, medical history, and comorbidities. But some argue that it is unfair to expect safety-net hospitals to be as effective in preventing readmissions as other facilities because their patients are sicker.

Others argue that an adjustment to the readmissions measures could give poor quality hospitals a pass.

Tinker Ready is a contributing writer at HealthLeaders Media.

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