I read with great interest the recent Q&A “We're trying to build the business case for achieving health equity,” (April 25, p. 30), based on an interview with Cara James, Ph.D., director of the CMS' Office of Minority Health. The OMH is working to close the gap on the pervasive health disparities experienced by communities of color. As part of this effort, it has developed tools that identify areas of need and issued guidance to improve population health.
James estimated that as much as 80% of health disparities are driven by social determinants of health. Further, she asserted that structural barriers prevent the healthcare system from addressing these social factors.
Unfortunately, there's a disconnect between CMS' rhetoric and policy. While the OMH pledges to work with providers to educate them about responsibilities for providing services to people with social complexities, the CMS' Hospital Readmission Reduction Program is disproportionately stripping safety net hospitals of the resources needed to deliver on this goal. The disconnect is compounded by other CMS efforts—including the planned overall hospital quality star-rating system—that fail to appropriately adjust for the community-based health disparities that influence hospitals' ability to care for patients on the lower rungs of the social ladder.
Our data support James' assertion that healthcare needs vary significantly from “one geographic location to the next, or from one community to the next.” In fact, I was joined by David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, in a column on the influence of sociodemographic status in Modern Healthcare this year.
Meeting the shared goal of reducing disparities—a priority for OMH and the nation's safety net providers—will require more resources, not less. A good starting point would be risk-adjusting the health-outcome measures used by the CMS to better account for the social factors that drive 80% of disparate health outcomes in the U.S. The result would be incentives and sanctions that reflect hospitals' quality rather than patients' communities.