Current quality measures are unfair to providers serving economically disadvantaged populations, National Quality Forum tells CMS

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Nursing homes and other healthcare providers face reduced reimbursements from government programs if they serve economically disadvantaged patients, according to a recent National Quality Forum report. NQF recommended adjustments to address this problem, but the government rejected the proposals.

The National Quality Forum is the main organization that sets healthcare quality standards used by Medicare and similar programs to assess providers. Currently, quality measures are not adjusted to account for the sociodemographics of a provider's patient population, such as patients' income and educational attainment. These factors should be considered because they are related to certain quality measures, such as hospital readmission rates, according to experts convened by NQF. Homeless people, for instance, lack resources to care for themselves and are more likely to be readmitted to a hospital.

The need to adjust quality measures for sociodemographic factors is especially pressing because the government increasingly is tying reimbursement to performance, the report states. This means that providers are incentivized to turn away vulnerable patients to maintain their quality ratings and their bottom lines. Furthermore, cash-strapped providers that continue to take on disadvantaged patients could see their quality ratings suffer and lose reimbursements, making it even more difficult for them to care for people who often have complex healthcare needs.

Not every quality measure should be risk adjusted for sociodemographics, the report proposes. Items that are strictly under provider control, such as “administering the right medication at the right time,” would be exempt.

The American Hospital Association and other prominent provider groups support the NQF's recommendations, but the Centers for Medicare & Medicaid Services has rejected them, the Bureau of National Affairs reported Tuesday. The recommendations are not based in evidence and are “premature,” CMS reportedly said in comments to the National Quality Forum.

The report was commissioned by the Department of Health and Human Services and written by an expert panel of 26 stakeholders, including providers and consumers. Click here to access a draft version dated March 18. A final version is forthcoming, BNA reported.

The NQF will host a call on May 9 to discuss next steps.

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