Risk adjustment may increase the accuracy of readmission-based, pay-for-performance ratings for children’s hospitals with high populations of patients affected by social determinants of health, according to recent research in JAMA Pediatrics.
“Does risk adjustment for social determinants of health affect hospitals’ penalty status on a readmissions-based, pay-for-performance measure in a national cohort of children’s hospitals,” Marion R. Sills, MD, MPH, of the department of pediatrics at the University of Colorado School of Medicine, and colleagues wrote in their study. “Social determinants of health are risk factors for readmissions-related penalties for children’s hospitals, and thus, risk adjustment for social determinants may reduce penalizing hospitals for patient factors beyond their control.”
The researchers analyzed 179,400 discharges from 43 children’s hospitals in 2013 to determine the impact of social determinants on readmission-based, pay-for-performance ratings. To develop an approximate baseline for the risk adjustment formula, the researchers used methods used by state Medicaid agencies. The social determinants of health risk adjustment factors were based on race, ethnicity, financial strain and ZIP code.
Study results showed that applying the social determinants of health risk adjustment resulted in a change of penalty status for three children’s hospitals within the potentially preventable readmission 15-day window, when compared with the baseline formula. The newly applied risk adjustment also changed the status for five children’s hospitals within the potentially preventable readmission 30-day window.
“Further work to characterize the effects of [social determinants of health] on performance measures may assist efforts to improve care quality and deliver more equitable care,” Sills and colleagues wrote.
In a related editorial, Jay G. Berry, MD, MPH, and Alyna T. Chien, MD, MS, both of the division of general pediatrics and department of medicine at Boston Children’s Hospital, wrote that the adjusted rates suggested by Sills and colleagues still do not represent a better indication of a given hospital’s quality of care.
“Ideally, the intent of performance assessment programs is to incentivize the delivery of high-quality, equitable health care,” Berry and Chien wrote. “As such, stakeholders interested in aligning payment with care quality should consider options beyond simply manipulating existing parameters of case-mix adjustment. They should channel their energy and creativity to determine better approaches, analyses, and display options for hospital performance so that it is easy for patients, health care professionals, payers and policymakers to determine how good of a job a hospital is doing for vulnerable subpopulations of patients and how that hospital could optimize its performance.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.