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Making the Case for Adjusting Quality Measures for Social Risk Factors

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As previously blogged in AboutHealthTransparency.org (AHT 4/6/21), an analysis published recently in Health Affairs suggests that accounting for social risk factors like poverty, housing instability and transportation insecurity can have meaningful impact on healthcare quality measures without compromising quality of care. The researchers concluded that adjusting for social risk factors will not necessarily mask or excuse poor quality. Instead, it can demonstrate exceptional levels of quality among safety-net providers.

State of Reform writes, however, that the Assistant Secretary of Planning and Evaluation, the principal advisor to the secretary of the U.S. Department of Health and Human Services, issued a report in June 2020 opposing adjustments for social risk factors.

Quality measures like mortality rates, readmission rates, complication rates, and average functional improvement are used to compare doctors, hospitals, home health agencies, and health plans. These measures are then applied to determine financial rewards and penalties for providers that perform relatively well or poorly. Because providers don’t treat the same mix of patients, and some patients are at higher or lower risk of poor outcome than others, some form of statistical adjustment is applied to level of the playing field for making comparisons.

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