There are steps the Centers for Medicare & Medicaid Services can take that incorporate sociodemographic factors into value-based payment programs, but they come with tradeoffs, according to a report from the National Academies of Sciences, Engineering and Medicine.
National Academies researchers, led by Donald Steinwachs, Ph.D., of Baltimore’s Johns Hopkins Bloomberg School of Public Health, analyzed risk factors and recommended CMS develop measures to account for several factors in the short term, including: income, education, race/ethnicity, language, nativity, marital/partnership status, neighborhood deprivation and housing.
The commission also identified risk factors that the government should consider for inclusion in the longer term but have too many practical obstacles to tackle in the short term. These factors include wealth, sexual orientation and gender identity, environmental measures of residential and community context, and access to social supports.
CMS payment measures in their current form do not incorporate sociodemographic factors, which has several disadvantages, according to the commission. For example, the lack of such measures give providers and payers incentive to exclude patients for whom social risk factors are present. It also runs the risk of underpaying providers who serve at-risk populations, echoing a common complaint about CMS measures from groups such as the American Hospital Association. However, introducing social risk factors to CMS measures could introduce its own problems, according to the report, such as giving providers less incentive to improve outcomes among vulnerable populations.
To incorporate sociodemographic factors into payments in a way that achieves balance, the researchers identified four categories CMS value-based programs should account for:
- Stratified public reporting
- Direct adjustment of payments incorporating social risk factors
- Direct payment adjustments
- Restructured payment incentive design
“Accounting for social risk factors in Medicare payments is not intended to obscure disparities that exist, but rather bring disparities to light,” Steinwachs said in a statement to press. “Payment systems should include sufficient incentives for quality improvement for both socially at-risk populations and to patients overall.”
- download the report (purchase may be required)