ASPE releases report on the impact of social risk factors on Medicare quality programs

Medicare beneficiaries with social risk factors had worse outcomes on a range of measures in Medicare quality programs, regardless of the providers they see, according to a report released today by the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services. The report finds that providers serving large numbers of beneficiaries with social risk factors had higher penalties on Medicare pay-for-performance programs, such as hospital readmissions and value-based purchasing, than other providers. “Dual enrollment status [in Medicare and Medicaid] was the most powerful predictor of poor outcomes,” notes the report. To account for the impact of social risk factors in Medicare programs, ASPE proposes measuring quality for beneficiaries with social risk factors, setting high and fair quality standards for all beneficiaries, and rewarding better outcomes for patients with social risk factors, among other actions. The report states that measures “should be examined to determine if adjustment for social risk factors is warranted; this determination will depend on the measure and its empirical relationship to social risk factors.” The report is first of two studies mandated by the Improving Post-Acute Care Transformation Act on how to account for social risk factors on Medicare quality measurement programs. For more, see HHS’s blog post.