Statement from NQF on Draft Report on Risk Adjustment for Socioeconomic Status 

Washington, DC - The National Quality Forum’s (NQF) Expert Panel draft report, Risk Adjustment for Socioeconomic Status and Other Sociodemographic Factorsis undergoing NQF’s multi-phased, standard review process.  

On April 16^th, NQF completed a month-long, national public comment period, allowing for individuals and organizations to submit their comments on the report.  NQF received 650 comments from 160 organizations and individuals. 

As part of the standard review, the Expert Panel will examine each comment, collect additional evidence as necessary and revise the report to find common ground.  The recommendations may change as a result.  The recommendations then must be reviewed and approved by both the Consensus Standards Advisory Committee (CSAC) and the NQF Board of Directors.   A final report is expected this summer.

Recent media coverage of the draft report requires that several points about the draft report be clarified:

• The Expert Panel that authored the draft report was instructed to review and make recommendation about NQF’s current policy on risk adjustment for sociodemographic factors, not federal policy;
• The Expert Panel made recommendations in the draft report to NQF; the recommendations were not developed by NQF;
• The report’s draft recommendations would not apply universally to all performance measures – there would need to be demonstrated evidence of a causal relationship and support in an empirical model.  For example, a measure of catheter-associated bloodstream infection would not be adjusted for sociodemographic factors since there is no conceptual or empirical relationship between acquiring a catheter-associated infection in the hospital and factors such as poverty or homelessness, whereas a measure of a patient's taking prescribed medications might be adjusted for sociodemographic factors if supported by empirical analysis.  
• The recommendations are general; no specific performance measures are identified in the report for risk adjustment.
• The Expert Panel had not concluded the exact impact of existing payment policies but voiced its concern that current policies may worsen disparities.
• The Centers for Medicare and Medicaid (CMS) requested that NQF conduct this project and it is funded by the agency.

 Learn more about the project.