Washington, DC – The National Quality Forum has upheld endorsement of three measures of hospital care costs without risk adjustment for socioeconomic status (SES). These measures were included in a groundbreaking trial underway to determine whether NQF should permanently change its policy and allow SES risk adjustment of measures.
The measures, NQF #2431, 2436, and 2579, assess hospital-level risk-standardized payment associated with a 30-day episode of care for acute myocardial infarction (AMI), heart failure, and pneumonia, respectively. The Centers for Medicare & Medicaid Services (CMS) in August finalized the measures for AMI and heart failure for use in the Hospital Value-Based Purchasing Program beginning in fiscal year 2021. CMS previously adopted all three measures for the Hospital Inpatient Quality Reporting Program.
NQF endorsed the measures with conditions, including that they be part of NQF’s SES trial. The inclusion of these measures in the trial showed that risk adjustment for SES with available data did not have a significant impact on measure results, and NQF subsequently endorsed the measures without SES risk adjustment. The American Medical Association, American Hospital Association, America’s Essential Hospitals, the Federation of American Hospitals, and the Association of American Medical Colleges appealed this decision.
“For months, we have had a series of very in-depth, thoughtful discussions with the appellants, the measure developer, and with CMS to better understand the concerns of all, identify and analyze new data, and determine a path forward,” said Helen Darling, NQF interim president and CEO. “These discussions have added greatly to the knowledge base on this issue and revealed the data challenges we face to accurately adjust measures for socioeconomic factors and ultimately, reduce disparities in health and healthcare.”
NQF will solicit feedback on the implementation of these measures as they are used in federal programs and will consider future availability of SES data for risk adjustment.
NQF’s efforts focused on SES risk adjustment reflect a broader organizational commitment to achieve health equity, particularly for vulnerable populations. NQF recently announced a new project, funded by CMS, to determine how measurement can 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.
