The impact of socio-demographic factors on 30-day hospital readmissions
will be the focus of a robust new National Quality Forum
trial, the organization announced Wednesday. The trial will consider such factors as income, education, race and primary language.
Hospitals routinely face financial penalties from the CMS for the return of excess numbers of patients with certain conditions within a month of discharge. Health policy advocates have argued hospitals in poor communities may be unfairly penalized by the CMS policy because of factors beyond their control that contribute to patients' overall poor health.
The NQF plans to investigate the issue, creating a disparities committee to help with its assessment, according to a news release.
In a draft report released earlier this year
, the nonprofit, member-based quality improvement organization stated that failing to adjust performance measures for socio-demographic factors could produce incorrect conclusions about quality. The NQF plans to follow through with recommendations laid out in that report, which included establishing guidelines for selecting performance measures, setting expectations for the information needed to track them, and identifying a standard set of socio-demographic variables, among others. Details about the trial duration and specific measures have not yet been established.
The NQF expert panel's report did not prejudge what measures were appropriate, but created a path for thinking about a range of them, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.
“We believe the panel's report offered a much better way to be able to understand disparities in patient outcomes,” she said.
A growing body of research suggests the impact of 30-day readmissions penalties on safety net hospitals may be disproportionately higher, since those facilities often care for more patients in challenging economic and demographic circumstances.
For example, a study from Truven's Center for Healthcare Analytics
released in June found about 18% of a community's readmissions can be attributed to unemployment. The analysis also found that about 6% of readmissions could be attributed to poverty among the elderly, and that the chances of a black patient being readmitted to a hospital were almost 15% higher than they were for a white person who was otherwise similar.
Safety net hospitals like Henry Ford Hospital in Detroit say they support the NQF action. Henry Ford received CMS penalties in both 2013 and 2014 despite its efforts to improve patient care and reduce readmissions through partnerships with community healthcare workers, language programs and other services.
“This is a significant change in policy,” said David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System. The NQF action, he said, reflects the special challenges of using outcome measures to evaluate and compare health plans and providers.
“It will not always be easy to know when adjustment is appropriate, but the NQF Board decision yesterday opens the door so that we can learn about how and when best to do it,” he said.Follow Sabriya Rice on Twitter: @MHSRice