A new era of health care quality is quickly approaching. With the implementation of the Affordable Care Act, new standards for quality of care and performance are reshaping health care delivery, rewards, and penalties. But what does this mean for essential hospitals that care disproportionately for sicker, more complex patients?
The National Quality Forum (NQF) this year sought to set standards for quality and performance that account for these patients. Although NQF stopped short of firm recommendations, its Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors work added to momentum for considering social factors in measures of outcomes and resource use.
In a recent NQF video, our president and CEO and NQF board member Bruce Siegel, MD, MPH, addressed the importance of adjusting for sociodemographic factors. As Siegel describes it, the effects of social factors, such as financial instability or limited health care access, may lead to increased hospitalizations for many patients of essential hospitals. This overutilization has the potential to skew quality and performance outcomes, despite the high quality standards of the institution.
This is especially troubling in the context of care improvement programs that penalize poor performance, Siegel says. For example, the Center for Medicare & Medicaid’s Readmission Reduction Program reduces hospital funding for excessive readmissions. Likewise, the shift toward pay-for-performance payment models is rewarding or withholding payments based on quality and performance outcomes.
While it is important to strive for such quality and performance improvements, these penalties might actually be counterproductive for essential hospitals, whose patients are often sicker and higher utilizers than those at other hospitals. Penalizing the hospital might actually deprive patients of vital resources they need.
Adjusting for sociodemographic factors in quality and performance measures is challenging work that will not produce results overnight. But NQF, America’s Essential Hospitals, and other stakeholders have created a forum for problem-solving that has advanced this important work.
Are you involved in work addressing social factors? Please share your stories with us in the comments below!