The American Hospital Association asked the National Quality Forum (NQF) to implement recommendations to provide risk-adjusted quality measures to account for sociodemographic factors such as Medicaid status, income, education and homelessness.
"Sociodemographic adjustment allows for all providers to be fairly and accurately assessed on the quality of care they provide and their contribution to patient outcomes while mitigating negative unintended consequences of measurement," Rick Pollack, executive vice president of the AHA, wrote in the letter.
Although recommendation implementation would be complex, the AHA said, it is critical to act as soon as possible, as failing to adjust for sociodemographic factors will substantially affect hospitals. Those factors also worsen healthcare disparities by "diverting resources away from hospitals and other providers treating large proportions of disadvantaged patients," the AHA said.
Some argue that sociodemographic adjustment lowers standards of care, but those adjustments would hold all measured providers to the same standard of care, and enable a more accurate comparison of quality of care provided by eliminating confounding factors beyond the providers' control, the letter argued.
Proposed NQF recommendations directed at adjusting performance measures for sociodemographic factors include:
Distinguishing different methods for the different purposes of measurement: sociodemographic adjustment for accountability and stratification for identifying disparities
Revision of NQF criteria related to risk adjustment to include sociodemographic factors as appropriate
Guidelines for selecting risk factors to include appropriate sociodemographic adjustment
Expectations for information needed when outcome measures that may be adjusted for sociodemographic factors are submitted to NQF
A recent study found hospitals are more likely to suffer costly penalties from the Centers for Medicare & Medicaid Services if they treat more dual-eligible seniors--patients on both Medicare and Medicaid, FierceHealthcare previously reported. The hospitals were in regions with fewer or lower-quality primary care resources, increasing the likelihood of a patient readmission within 30 days.