A large and growing body of evidence shows that sociodemographic factors – age, race, ethnicity, and language, for example – and socioeconomic status (SES), such as income and education, can influence health outcomes. These findings are particularly significant for payment programs that reward or penalize hospitals for the quality of care they provide.
Experts, including an ad-hoc committee of the National Academies of Sciences, Engineering, and Medicine, have examined how social risk factors affect health outcomes and proposed accounting for these factors in Medicare payment programs that, without risk adjustment, disproportionately penalize hospitals that serve vulnerable people. Risk adjustment can include stratified public reporting for patient characteristics, adjustment of performance scores, direct adjustment of payment, and restructured payment incentives.
America’s Essential Hospitals supports including sociodemographic and socioeconomic factors in the risk adjustment of outcomes measures when conceptual and empirical evidence warrants it. Doing so will improve the science of performance measurement by increasing precision and delivering more accurate information to providers, payers, and the public.
Here, find a periodically updated list of research and other resources on the need to risk adjust performance measures for socioeconomic and sociodemographic factors. For further information or to add to this list, please contact INSTITUTE.firstname.lastname@example.org.
Essential Hospitals Champion SES Adjustment in Medicare HRRP
More than 100 CEOs and other executives of hospital committed to caring for vulnerable patients have asked Congress to pass legislation, the Establishing Beneficiary Equity in the Hospital Readmission Program Act (S.688/H.R.1343), that would bring socioeconomic status risk adjustment to the Medicare Hospital Readmissions Reduction Program (HRRP). Read the letter »
In December 2016, the association and its members achieved a major advocacy victory with President Obama’s signing of the 21st Century Cures Act, which requires, for the first time, socioeconomic risk adjustment of federal hospital readmissions measures.
The Evidence for SES Risk Adjustment