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Apr. 30—Providers that treat low-income patients should not be penalized by federal quality standards that unfairly compare them with providers that treat mostly higher-income patients, a study commissioned by the Obama administration concluded.
Federal payment policies that reward high-quality healthcare and penalize hospitals and physicians with many low-income patients that fail to meet such quality standards require “sweeping” changes, a draft report by National Quality Forum (NQF) panel recommended, according to The New York Times. The NQF did not respond to requests for the report.
The consensus-based group, which included representatives of consumer groups, insurers, healthcare providers, and employers, said increasingly used quality measures are fundamentally flawed. That conclusion was based on the lack of any adjustments in the policies for account for more low-income patients, who are harder to treat due to lower treatment compliance and other factors.
Payment policies, the panel concluded, unintentionally worsen disparities by shifting money away from doctors and hospitals that care for “disadvantaged patients.”
The panel urged Medicare and private insurers to calculate financial rewards and penalties by adjusting for various “sociodemographic factors.”
Many provisions of the Affordable Care Act aim to improve care by tying Medicare payments to the performance of hospitals and other providers on quality measures. For instance, Medicare has begun to reduce payments to hospitals with higher-than-average readmissions.
Obama administration officials said adjusting the data for social or demographic factors would be equivalent to accepting a double standard, with lower expectations for the care provided to low-income patients.
Previously, the Medicare Payment Advisory Commission, which is Congress’ primary Medicare advisor, has found that lower-income patients have higher readmission rates and major teaching hospitals, which serve large numbers of indigent patients, face the highest penalties.
Among possible changes suggested by the panel were for payers to compare providers with other providers who serve similar proportions of low-income patients.
The American Hospital Association endorsed the panel’s recommendations and urged the Centers for Medicare & Medicaid Services (CMS) to quickly adopt the changes.
"A large body of evidence demonstrates that sociodemographic factors such as income and insurance status affect many patient outcomes, including readmissions and costs," Rick Pollack, executive vice president for AHA, wrote to CMS and NQF. “The current approach used to measure and report outcomes, such as CMS’s measures of mortality, readmissions and cost per beneficiary, does not include this type of analysis, and effectively assumes that any disparities in outcomes are attributable only to either how sick the patient is or to the quality of care provided by the hospital.”
Publication Date: Thursday, May 01, 2014
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
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