New Study Raises Concerns over Ineffective Accounting for Social Risk Factors by Medicare Hospital Compare

Original story posted on: January 15, 2020

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    The Social Determinants of Health: Case Management's Next Frontier

Monitor Monday's listeners polled for proposed solutions.

2020 began as it ended, with the healthcare industry fixation on every nook and cranny of the social determinants of health (SDoH). Many experts are still reeling from allegations of inherent bias in algorithms used across the nation. And a new study involving Medicare Hospital Compare is adding fuel to the bias fire.

The study, published in Medical Care, through the American Public Health Association, linked 2017 Medicare Hospital Compare ratings with block group data from the 2015 American Community Survey, which assesses hospital ratings as a function of neighborhood social risk factors. The goal of the study was to examine the relationship between the ratings and neighborhood social risks, but it revealed a larger industry challenge:

Study details:

  • Number = 3,608 Medicare-certified hospitals across 50 states
  • Measures included hospital summary scores and seven quality group scores (using a 100-percentile scale):
    • Effectiveness of care
    • Efficiency of care
    • Hospital readmissions
    • Mortality
    • Patient experience
    • Safety of care, and timeliness of care.
  • Lower hospital summary scores were associated with caring for neighborhoods with higher social risk, including a reduction in hospital scores for every 10 percent of residents who:
    • Are dually eligible for Medicare/Medicaid
    • Have no high-school diploma
    • Are unemployed
    • Self-identified as black
    • Reported high travel times to work

The associations between neighborhood social risk factors and hospital ratings were the smallest in the areas of safety, efficiency, and effectiveness of care groups. The areas with the largest associations were:

  • Timeliness of care
  • Patient experience
  • Hospital readmissions

Could this be another situation of totally unintentional bias in a rating system? Just as safety-net hospitals are righting themselves after the inequity of initial readmission payment penalties, are they now poised for another financial hit? Medicare could be underpaying hospitals that serve communities most at risk for the social determinants, simply because of a skewed rating system; these are the hospitals that need the dollars the most. The outcomes gathered are only as good as the tools developed, and those tools must reflect appropriate measures and context. As an article about the study states, “failing to account for neighborhood social risk in hospital ratings may reinforce hidden disincentives to care for medically underserved areas in the United States.”

We asked our Monitor Mondays listeners in the first survey of 2020 about their choice of a mitigation plan for Medicare Hospital Compare. Here are the results:

How should Medicare Hospital Compare reconcile the issue of accounting for Neighborhood Social Risk?
  • Pull together industry stakeholders to develop SDoH specific recommendations
  • Obtain data on how much reimbursement was lost across hospitals and health systems
  • Revamp the Medicare Hospital Compare rating system
  • Scrap Medicare Hospital Compare: I never liked it anyway!

Programming Note:  Listen to Ellen Fink-Samnick’s live reporting on the State of the Union of SDoH on Monitor Monday, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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