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Report Questions Fairness of Medicare Quality and Incentive Programs

A draft technical report by the National Quality Forum has called into question the fairness of Affordable Care Act Medicare programs that seek to provide financial incentives to hospitals that meet selected quality care standards and penalize those that fail to meet those standards.

According to the report, which was commissioned by the Obama administration, these programs unfairly penalize hospitals that care for especially large numbers of low-income seniors.

The report notes, according to the New York Times, that

Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.

iStock_000001497717XSmallAmong the programs cited for this problem are Medicare’s value-based purchasing program and its hospital readmissions reduction program.

The National Association of Urban Hospitals (NAUH) has long been on record expressing similar concerns and calling for Medicare to add a much-needed risk adjustment component to these programs.  NAUH has conveyed these concerns to the Centers for Medicare & Medicaid Services (CMS) on a number of occasions, including in a letter last year, and last month NAUH endorsed H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, which would require CMS to add such a risk adjustment component to the hospital readmissions reduction program.

Read more about the programs’ challenges, as well as the views of those who believe the programs are working as intended and should not be adjusted, in this New York Times article.  Go here, to the National Quality Forum’s web site, for a direct link to the study, titled “Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors.”

 

 

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