Today, the National Academy of Medicine (NAM) released the first in a planned series of reports that will identify “social risk factors” affecting the health outcomes of Medicare beneficiaries, and methods to account for these factors in Medicare payment programs like the Hospital Readmission Reduction Program. Through a comprehensive review of available literature, the NAM’s expert panel found evidence that a wide variety of social risk factors may influence performance on certain health care outcome measures such as readmissions, costs, and patient experience of care. These social risk factors include:

  • Socioeconomic position (e.g., income, education level)
  • Race, ethnicity and cultural context
  • Gender
  • Social relationships (e.g., marital status, living alone)
  • Residential and community context (e.g., housing, availability of transportation)

This important report provides evidence-based confirmation of what hospitals and many policymakers have long known – socioeconomic and other social risk factors matter greatly in measuring the quality of hospitals. That is why MedPAC recommended socioeconomic adjustment for the readmissions penalty program in 2013, and why the National Quality Forum’s 2014 expert panel recommendations on sociodemographic adjustment received widespread support. The American Hospital Association (AHA) has long advocated that Medicare incorporate socioeconomic adjustment into its quality measurement and pay-for-performance programs when there is conceptual and empirical evidence supporting the need for adjustment. The AHA already supports the Establishing Beneficiary Equity in the Hospital Readmission Program Act (S. 688/H.R. 1343), bipartisan, bicameral legislation which would require CMS to incorporate a socioeconomic adjustment factor to improve the fairness of the readmission penalty program.

The AHA will continue to work with Medicare, Congress and all interested parties to ensure quality reporting and pay-for-performance programs include sociodemographic adjustment as needed.

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