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NAM Releases Final Report on Social Risk Factors and Medicare Payment

The National Academy of Medicine (NAM) has released its fifth and final report in a series by an ad hoc committee focused on social risk factors that affect the health outcomes of Medicare beneficiaries.

The previous reports focused on defining a conceptual framework; identifying practices that could improve care for socially at-risk populations; providing guidance on which social risk factors should be accounted for in Medicare payment programs; and offering guidance on collecting data on social risk factor indicators that should be considered in Medicare quality and payment programs.

In the fifth report, the committee puts the previous reports in context and recommends four goals for considering social risk factors in Medicare payment programs:

  • reducing disparities in access to care, outcomes, and quality;
  • improving care quality and efficiency for all patients;
  • ensuring accurate and fair reporting; and
  • fairly compensating insurers and providers.

America’s Essential Hospitals has been a leading advocate for risk-adjustment based on socioeconomic status for measures in Medicare quality programs to ensure that hospitals caring for vulnerable patients are not disproportionately and unfairly penalized for the challenges their patients face. 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.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.