Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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C1: Introduction
C1: Introduction
Pages 335-342
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From page 335... ...
. These findings are a concern for policymakers and health care providers because Medicare beneficiaries with social risk factors for poor health care outcomes are disproportionately concentrated among a subset of health care providers (Bach et al., 2004; Jha et al., 2007, 2008)
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. A wide range of stakeholders has raised concerns that current Medicare quality measures and payment programs that financially reward or penalize providers based on the health care outcomes of their patients and do not account for social risk factors may underestimate the quality of care for such providers.
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. If the goal of VBP odels m is to improve quality and control costs while simultaneously enhancing health care equity and improving outcomes for disadvantaged patients, careful attention must be paid to the delicate balance between adjusting payments and quality measures and preserving incentives to improve the care these patients receive.
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contracted with the National Academies of Sciences, Engineering, and Medicine to convene an ad hoc committee to identify criteria for selecting social risk factors, specific social risk factors Medicare could use, and methods of accounting for those factors in Medicare quality measurement and payment applications. The committee comprises expertise in health care quality, clinical medicine, health services research, health disparities, social determinants of health, risk adjustment, and Medicare programs (see Appendix F for biographical sketches)
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The committee's work will be conducted in phases and produce five brief reports, which build on the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine's previous studies relevant to this study. The first report will: • efine socioeconomic status for the purpose of application to quality, re D source use, or other measures used for Medicare payment programs.
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To achieve these goals, accounting for social risk factors should neither mask low-quality care or health disparities nor reward poor performance. Additionally, inclusion of social risk factors in quality measurement and payment should not disincentivize providers from finding strategies to overcome the influence of social risk factors on health care outcomes.
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2014. Quality reporting that addresses disparities in health care.
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