Despite a general push from the Centers for Medicare & Medicaid to tie payments to quality, some advisors are urging the agency to make adjustments to ratings that account for low-income beneficiaries.

In a letter sent last week to CMS Acting Administrator Andy Slavitt, the Medicare Payment Advisory Commission said CMS should use a Categorical Adjustment Index, which looks at differences in performance measures based on the socioeconomic status of MA enrollees, to calculate MA quality ratings. The adjustment index would be an interim approach until CMS develops a more “analytically rigorous” system, MedPAC noted.

An adjustment factor that takes low-income and disability status of enrollees into account would hopefully even out “systematic differences” among outcomes for low- and high-income MA beneficiaries although these differences tend to be “relatively small.” For some quality measures, low-income populations had stronger performance than high-income enrollees, the letter, MedAPC noted.

Recent research found outcomes for 19 quality measures for MA dual eligibles were worse for low-income beneficiaries compared to high-income enrollees in the same contract.  Medicare Advantage plans provide both Part A and Part B benefits, and are rewarded with higher payments for higher risk scores because they reflect better beneficiary health status.