Accounting for Social Risk Factors in Medicare Payment (2017) / Chapter Skim
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D2: Potential Data Sources
D2: Potential Data Sources
Pages 481-494
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From page 481... ...
could include in quality measurement and payment, criteria to identify these factors, and methods to do so. For CMS to account for social risk factors in Medicare quality measurement and payment programs using these approaches, it is logical that it must first have accurate data on the social risk factors of Medicare beneficiaries.
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NEW AND EXISTING SOURCES OF CMS DATA CMS possesses a variety of data sources, some of which include data on social risk factors of Medicare beneficiaries. Existing sources of social risk factor data include administrative records and surveys of enrollees and patients.
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From page 483... ...
Additionally, if CMS were to collect new social risk factor data for inclusion in Medicare quality measurement and payment programs, it could design measures and data collection methodologies to ensure collection of accurate data that meet the needs of the intended method to account for those social risk factors in Medicare quality measurement and payment programs. At the same time, such new data collection on the social risk factors also need not be restricted to Medicare quality measurement and payment applications.
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From page 484... ...
Relatedly, even if sufficient samples are available to account for social risk factors in measuring some outcomes, data on social risk factors from one source may not generalize or be able to be applied to other outcome measures from another source. In regard to new data collection, doing so would require clearance of new items to survey questionnaires or administrative form from the White House Office of Management and Budget, which is especially concerned about collection burden, and such clearance processes could be a barrier to collecting new data.
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From page 485... ...
Although the purpose of that report was to identify social and behavioral domains that should be captured in EHRs to enhance patient care by capturing information important to providers in providing health care, there is some overlap between the social risk factors listed in this earlier IOM report and those identified in the committee's third report. Moreover, although the tasks for the two committees and the resulting two reports diverge, application of EHR data in Medicare performance measurement and payment can be considered another form of meaningful use and such application provides additional rationale for incentivizing widespread adoption of standardized collection and reporting of data from EHRs to CMS, including social risk factor data.
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From page 486... ...
Although CMS has infrastructure for both performance and claims reporting that it could enhance to include reporting of social risk factors, because only limited social risk factor data are currently collected through EHRs, CMS would still need to identify or develop and validate measurement standards for collection of new social risk factors. In addition, data can be added to EHR and other electronic systems through different modes of collection.
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From page 487... ...
Adding social risk factors to EHRs may require software upgrades or additional programming; modifying workflows of the clinical team to collect, enter, and manage social risk factor data in the EHR; educating providers on data collection methods to ensure accurate data; ensuring data storage systems and methods to share social risk factor data with other providers and administrators or researchers are secure; and, in some cases, intervening on or otherwise addressing social risk factors through tailored care approaches or referring patients to social service or public health agencies or community organizations that can address unmet social needs (IOM, 2014)
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From page 488... ...
These data include data that could be linked to Medicare beneficiary data at the individual level, area-level data that could be used to describe a Medicare beneficiary's residential environment or serve as a proxy for individual effects, and data that could help CMS to determine how to elicit information on social risk factors from Medicare beneficiaries. The primary advantage of using administrative and survey data from other agencies is that these data sources contain substantial information on social risk factors, and data from these sources are collected using standardized and validated measures and methodologies.
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For example, the design of these surveys includes standardized and validated measures and data collection methods to which CMS could refer when developing and refining its own measures and strategies to collect social risk factor data. However, because sample sizes of older adults in these national surveys are small, data from these surveys is unlikely to be useful to link to Medicare beneficiary data at the individual-level for use in Medicare quality measurement and payment.
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National surveys that collect data on social risk factors and which may be useful to CMS are the Health and Retirement Study (HRS) , National Health & Aging Trends Study (NHATS)
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2013a. Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012.
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2016. Accounting for social risk factors in Medicare payment: Criteria, factors, and methods.
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-- Medicare linked data. https://www.resdac.org/cms-data/files/nhats (accessed August 4, 2016)
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