Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs

Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program

“…Regardless of on which side of the debate one sits, it is inarguable that this decision has real consequences: Current policies, not only in the HRRP but also other value-based payment programs in Medicare, are disproportionately penalizing providers that serve the poor and disabled. 28,[37][38][39][40][41][42][43][44] Our findings are consistent with prior studies demonstrating a relationship between claims-based measures of social risk and…”

“…In fact, even with adjustment, safety‐net hospitals had somewhat worse performance than wealthier hospitals; whether this represents true differences in the quality of care delivered by each hospital, or residual confounding by factors beyond hospitals’ control, is unknown. Regardless of on which side of the debate one sits, it is inarguable that this decision has real consequences: Current policies, not only in the HRRP but also other value‐based payment programs in Medicare, are disproportionately penalizing providers that serve the poor and disabled …”

Association of the Comprehensive Care for Joint Replacement Model With Disparities in the Use of Total Hip and Total Knee Replacement

“…We chose dual eligibility as a proxy for socioeconomic status because of its strong dependence on having low income. 7 , 30 , 31 We controlled for the calendar year and patient-level risk factors, such as age, sex, and binary indicators for 24 chronic conditions (eTable 1 in the Supplement ), in a multivariable analysis.…”

Association of Hospital Payment Profiles With Variation in 30-Day Medicare Cost for Inpatients With Heart Failure or Pneumonia

“…5 A concern, however, is that these measures instead may reflect differences in case mix. 6,7 Although the payment measures are adjusted for demographic and clinical factors, unmeasured variations in patient populations of different hospitals may be associated with resource use in and out of the hospital. However, disentangling the intrinsic patterns of resource use from patient factors is difficult.…”