There is also a need for better reporting and measurement of social conditions that are outside the hospital's control. Montefiore Medical Center, a safety-net provider in New York, is expected to be hit with a 1.26% penalty next year. About 85% of its patient mix is Medicare and Medicaid beneficiaries.
Dr. Peter Shamamian, chief quality officer at Montefiore, said if the hospital could report that a readmission occurred because a patient struggled to follow a care plan due to social conditions, it could avoid a penalty. "That is important and it hits home for us," he said. The CMS' recent attempt at taking such factors into account didn't yield meaningful results.
Still, the CMS in 2019 plans to begin accounting for patients' socio-economic status so the program is fairer for safety-net hospitals such as Montefiore and Yale. But experts don't think it'll help much because income is just one social risk factor, and the data on other factors—such as if a patient is frail or can't drive—simply don't exist in any standardized way.
"We don't have good measures," said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins. A federal agency should be tasked with looking at data metrics so more progress can be made in developing measures.
Measurements that address patients' well-being could help move the dial on not only keeping patients from coming back to the hospital, but from needing to go in the first place. If a doctor knows before prescribing a medication that the patient doesn't drive and won't be able to get to the pharmacy, other interventions can be put in place to help them, said Dr. Karen Joynt, an assistant professor of medicine at Washington University School of Medicine. "How can we innovate around social risk and outpatient needs that really impact health?" she said. "The more money that gets put into value-based payment, the more critical it is that the metrics are improved."