The AHA also has expressed concern about the impact of dual-eligibles, or those enrolled in both Medicare and Medicaid, and a group that is often a proxy for socio-economic status in research studies. Socio-economic status and race “tend to go together. It is hard to separate the two,” says Nancy Foster, the AHA's vice president of quality and patient-safety policy.
Nonetheless, officials at the CMS rejected the idea of adjusting readmission measures to account for disparities in outcomes based on race in its final rule for the hospital readmissions reduction program. To explain their decision, CMS officials wrote, “Differences in the quality of healthcare received by certain racial and ethnic groups may be obscured if the measures risk-adjust for race and ethnicity. Also, risk-adjusting for patient race, for instance, may suggest that hospitals with a high proportion of minority patients are held to different standards of quality than hospitals treating fewer minority patients.”
What does the CMS' current stance on the issue mean for hospital executives? “Adjusting for race and understanding racial disparities is a complex topic,” says Dr. Anthony Slonim, executive vice president and chief medical officer at West Orange, N.J.-based Barnabas Health, which includes two hospitals on this year's 100 Top list: Community Medical Center in Toms River, N.J., and Clara Maass Medical Center in Belleville, N.J. “There is so much confounding that goes on when you are looking at something generic like white vs. black that you need more context to make it actionable. What it requires for me is to dig deeply into my context of care and better understand the circumstances.”
At Barnabas, he adds, “Race has not been a major category for us. I could set up a program for African-Americans, but that does me less good than identifying the health literacy problem and making sure that all patients, regardless of race, know how to take their medicines.”
Health literacy figures prominently into a program Barnabas launched this year to reduce readmissions among patients with congestive heart failure. All heart failure patients receive at least one phone call after discharge; those at higher risk for readmission get additional phone calls and, in some cases, home-care visits.
The focus of all of the personalized attention is to ensure that patients understand their disease and all of their discharge instructions, including their medication regimen.
Barnabas launched the program at Community Medical Center and Kimball Medical Center, Lakewood, N.J. Clara Maass Medical Center is scheduled to roll out the program next.