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Analysis

Hospitals Might Get Penalized by CMS for Serving Disadvantaged Patients

By Jack O'Brien  
   January 08, 2020

Provider organizations servicing vulnerable communities could be judged on "social factors outside of their control," according to the study.

Hospitals that serve disadvantaged patients in vulnerable communities may be unfairly penalized by the Centers for Medicare and Medicaid Services (CMS) rating system, according to an analysis released by the University of Chicago Medicine Wednesday morning.

The study found that the CMS rating system does not account for social risk factors (SRF) and as a result, provider organizations could be judged on "social factors outside of their control."

Researchers found that in an analysis of more than 3,600 hospitals across the country, those that provide care in neighborhoods with higher social risks achieved lower quality scores from CMS. 

Hospitals are likely to be judged, and potentially penalized, based on geographic location, Elizabeth Tung, MD, MS, lead author of the study, said. 

“Living in a disadvantaged community can influence health directly through social factors like substandard housing conditions, inadequate access to food or transportation, and high levels of stress due to safety concerns," Tung said in a statement. "These factors work against well-being, so patients from these neighborhoods have more barriers to health to begin with.”

The study found that hospitals in disadvantaged neighborhoods lagged in scores for timeliness of care, largely a measure of emergency room wait times, and hospital readmissions.

However, researchers said that safety, efficiency, and effectiveness of care were "minimally affected" by SRFs.

Hospitals have criticized CMS' Overall Hospital Quality Star Ratings since the system was put into place in 2016, often calling for major changes or elimination of the program.

Last February, the rating system was updated for the first time since 2017 and in August, CMS announced plans to "update" Star Ratings in 2021.

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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