Outcome Quality Measures: Risk Adjustment for Socioeconomic Status

Outcome Quality Measures: Risk Adjustment for Socioeconomic Status Outcome Quality Measures: Risk Adjustment for Socioeconomic Status Susannah M. [...] Is this the right solution? • Measures that illuminate healthcare quality • Programs that incentivize improvements in care and outcomes and lessen disparities • A strong healthcare safety net Is this the right solution for these goals? Outline • Measuring quality: – Why SES is not just like other risk-factors • Improving outcomes: – Hospital Readmission Reduction Program • Protecting the safety-ne. [...] Poor and minority patients receive lower quality care “There is a significant gap for all Americans between best possible care and that which is routinely delivered; and this gap is larger for patients who are members of minority groups, poor, of lower educational level, or disabled” -- Carolyn Clancy The challenge of healthcare disparities and quality measurement • Poor and minority patients rece. [...] Health Aff 2012;31:1739-1748 Safety net hospitals achieve good outcomes Readmission Reduction Program • Improving patient outcomes • Improving safety-net performance • Little impact of risk-adjustment for SES Improving patient outcomes Impact of risk-adjustment Is this the right solution? Protecting the healthcare safety net Measurement versus implementation • Risks of changing measures – Legacy o. [...] if we had evidence that a pill helped low socioeconomic status patients avoid readmission, we might cover the cost for it, but in the case of readmission, that pill might actually be resource-intensive services such as social workers, extra time with translators, follow-up phone calls or bus rides to the next appointment.” Alternatives • Peer-group thresholds for penalty (MedPAC) – Single measure.