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Payment Reform Strategies, More Evidence Supporting SES Risk-Adjustment

These recent journal articles, selected by our lead researchers, highlight important issues related to socioeconomic status (SES) and payment reform.

Readmissions and SES

Socioeconomic Status and Readmissions: Evidence from an Urban Teaching Hospital (subscription required)

Several socioeconomic factors have been found to influence readmissions, but the Centers for Medicare & Medicaid Services (CMS) does not adjust for patients’ socioeconomic status in the calculation of readmission rates. This May Health Affairs article shares results of a recent study conducted at America’s Essential Hospital member Henry Ford Hospital, which found that patients in high-poverty neighborhoods were 24 percent more likely than others to be readmitted, and married patients were at significantly reduced risk of readmission.

Adding Socioeconomic Data to Hospital Readmissions Calculations May Produce More Useful Results (subscription required)

Researchers studied hospital readmissions data for nonfederal acute care and critical access hospital patients in Missouri diagnosed with acute myocardial infarction, heart failure, or pneumonia using the following two models:

  • CMS’ current model for public reporting of condition-specific hospital readmission rates for Medicare patients
  • a model that incorporated socioeconomic data, including poverty rate, education, and housing vacancy rate

The study found that including socioeconomic factors had a significant impact on the calculated hospital readmissions rates for these patients. Results were published in a May Health Affairs article.

For more on SES, check out this extensive list of resources previously collected by staff.

Payment Reform

Successes and Failures of Pay-for-Performance in the United Kingdom (subscription required)

In 2004, the United Kingdom introduced the quality and outcomes framework, a pay-for-performance program that tied 25 percent of family practitioners’ payments to quality performance. In this New England Journal of Medicine health policy report, authors recap the program’s performance since its inception, including successes and failures.

The Payment Reform Paradox (subscription required)

Health policy makers are relying on unproven strategies, including accountable care organizations and bundled payments to control spending growth. Author Rob Cunningham explores the positives and negatives of both in this May Health Affairs article.



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