Washington, DC – The National Quality Forum (NQF) has endorsed 30 new and existing hospital and post-acute care (PAC) readmissions measures (PDF). Two PAC measures were adjusted for socioeconomic status (SES) and other demographic factors, specifically, insurance status and marital status.
The measures are used in various private and federal quality reporting and value-based purchasing programs, including the Centers for Medicare & Medicaid Services’ (CMS) Hospital Readmissions Reduction Program (HRRP). Most of the measures were included in a groundbreaking NQF trial to determine whether NQF should permanently change its policy and allow measures to be risk adjusted for SES. In most cases, and with all of the measures involving hospital readmissions, updated risk adjustment models did not show significant effects of SES risk adjustment.
“In its decision on these measures, the NQF Executive Committee, in accordance with NQF’s bylaws, adopted a recommendation that the NQF Board consider other approaches in addition to measurement to address the unintended consequences of federal payment programs, including the impact on hospitals that serve the nation’s most vulnerable patients,” said Helen Darling, MA, NQF’s interim president and CEO. “The 21st Century Cures Act includes a provision to change the HRRP so that hospitals’ performance is judged in comparison to like hospitals, instead of a national benchmark.”
NQF’s Executive Committee adopted the following recommendations in its decision regarding the readmissions measures:
- Given potential unintended effects of the readmission penalty program on patients, especially in safety net hospitals, NQF’s Measure Applications Partnership and the NQF Board are encouraged to consider other approaches to address these potential unintended consequences.
- NQF should focus efforts on the next generation of risk adjustment, including social risk as well as consideration of unmeasured clinical complexity.
- The Disparities Standing Committee will address unresolved issues and concerns regarding risk adjustment approaches, including potential for adjustment at the hospital and community levels.
- SES adjustor availability should be considered as part of the annual update process.
“NQF will continue to push toward better risk adjustment to ensure that vulnerable patients get the care they need and that safety net providers have the resources they need to provide high-quality care to all Americans,” said Darling.
NQF will consider future availability of SES data for risk adjustment during annual measure updates. In addition, NQF is soliciting feedback on the implementation of the measures as they are used in federal programs. NQF’s SES trial continues through April 2017, at which point NQF will decide whether to make SES adjustment of measures, under specific circumstances, its permanent policy.
NQF’s efforts focused on SES risk adjustment reflect a broader organizational commitment to achieve health equity, particularly for vulnerable populations. A new NQF project, funded by CMS, will identify how measurement can be used to more effectively reduce healthcare disparities.
“The ongoing work of the NQF SES trial, and the Disparities Standing Committee that oversees it, are critical inputs to the national dialogue about risk adjustment, payment strategies, and disparities reduction,” said Helen Burstin, NQF chief scientific officer. “NQF’s Disparities Committee will develop a roadmap to reduce disparities through measurement and focus on highest risk areas where effective interventions can make a difference.”
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The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement. Learn more at www.qualityforum.org.
