Sociodemographic Risk Adjustment: Protecting the Safety Net?
September 26, 2014
Sally Coberly, PhD & William J. Scanlon, PhD, Senior Consultant
How performance on quality and outcomes of care is measured and either rewarded or penalized can significantly affect not only health care providers' bottom lines, but also their willingness to treat those presumed to be more impaired or disadvantaged than the average patient. Presently, risk adjustment takes into account patients' clinical characteristics so that providers are not penalized for poor outcomes when treating sicker patients. The question at hand is whether risk adjustment should also consider socioeconomic status and other sociodemographic characteristics that may influence a patient's ability to access and effectively participate in his or her care. Some worry about instituting a double standard and undermining efforts to reduce disparities in access and care; others are concerned about the long-term economic viability of those who serve disadvantaged populations.
This issue has generated considerable interest over the past several years. The possible use of sociodemographic characteristics to risk-adjust outcome performance measures in the context of the hospital readmissions reduction program was examined by the Medicare Payment Advisory Commission in its June 2013 report. In July, the National Quality Forum agreed to lift its restriction on sociodemographic risk adjustment during a "robust trial period." And legislation has been introduced in both the House and Senate that would require the use of socioeconomic factors in various Medicare quality reporting and pay-for-performance programs. This Forum session examined the potential use of socioeconomic status and other sociodemographic factors in risk-adjusting performance measurement from a variety of perspectives.
National Quality Forum, "Risk Adjustment for Socioeconomic Status or other Sociodemographic Factors," Technical Report, August 15, 2014.