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Report IDs Social Risk Factor Criteria for Medicare Payments

A new National Academy of Medicine (NAM) report identifies criteria and methods to evaluate social risk factors for potential inclusion in Medicare value-based payment (VBP) programs.

The report specifies five criteria for selecting appropriate social risk factors for inclusion in performance indicators for VBP:

  • conceptual relationship with the outcome of interest
  • empirical association with the outcome of interest
  • risk factor presence at the start of care
  • risk factor is not modifiable through the provider’s actions
  • risk factor resistance to manipulation or gaming

This report, third in a series of five reports by NAM, aims to identify social risk factors that affect the health outcomes of Medicare beneficiaries, as well as methods to account for these factors in Medicare payment programs.

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

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

 

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.