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NQF urges Medicare performance measures that reflect demographics


By Virgil Dickson
Posted: April 28, 2014 - 3:45 pm ET
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The CMS should change current policy that may unfairly penalize providers who serve primarily low-income patients, the National Quality Forum says in a recent draft report. The NQF recommends including patient income, race and other factors in using quality measurements to assess provider performance and what providers are paid.

Such issues as a patient's income, race, homelessness and education should be used when Medicare is determining the quality of care providers are offering, the standards-creating organization says. Quality standards now in place don't evaluate the full picture of what contributes to a patient's health, the panel found.

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“As healthcare moves toward increasing use of financial rewards for better quality and financial penalties for worse quality, use of measures that result in incorrect conclusions about quality poses a substantial risk for penalizing healthcare organizations and providers who serve more disadvantaged populations,” the NQF says.

The report released last month (PDF) solicited comments from the healthcare community through April 16. A meeting is planned May 9 when next steps will be discussed.

The NQF received 650 comments from 160 organizations and individuals. The expert panel will revise the report based on the comments, with a final report expected in July. For any recommendations to become actual policy, they would need to be adopted and implemented by the CMS, states and private payers.

A CMS spokesman did not return a request for comment on the likelihood that the recommendations will be enacted by the federal agency.

The report was generated at the request of HHS. The agency wanted to look into the increasing concerns from policymakers and researchers who claim performance measures would be more accurate if they were adjusted for socio-demographic factors. Current quality measures aren't adjusted to include these factors based on the long-held belief that doing so would create a double standard of lower expectations for providers depending on their clientele.

The report's suggestions were nearly unanimously embraced by healthcare providers in the comments received by the National Quality Forum.

The American Hospital Association strongly urged the CMS to adopt the NQF panel's recommendations and adjust its measures. It also asked for the NQF to place a high priority on working with the CMS to rapidly address its measures.

“Failing to adjust measures for socio-demographic factors when necessary and appropriate can harm patients and worsen healthcare disparities by diverting resources away from hospitals and other providers treating large proportions of disadvantaged patients,” the trade group says.

There already have been consequences for providers, according to the Association of American Medical Colleges.

As a result of programs like CMS' hospital readmissions reduction program, safety-net providers are losing scarce resources necessary to care for vulnerable patients, which potentially entrenches disparities, the trade group says.

Not everyone agrees with the suggested changes, however. For example, while the NQF report notes that hospital readmissions can sometimes occur due to socio-demographic factors, it doesn't emphasize that many readmissions are required due to medical errors and infections that occurred during hospitalization, according to Consumers Union.

Further, there simply isn't enough data showing that evaluating these factors will truly lead to better outcomes for patients, according to the Leapfrog Group, a not-for-profit healthcare quality organization that conducts surveys on hospital safety and quality metrics.

“The recommendations outlined in the proposal are based on a belief, not fact, that not risk-adjusting may lead to lower performance scores for providers who serve disadvantaged patients,” Leapfrog says in a comment. “The report fails to provide sufficient evidence that the current policy harms patients to a degree that should compel the expert panel to recommend immediate action.”

Follow Virgil Dickson on Twitter: @MHvdickson


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