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  • Washington Highlights

    ASPE Releases First of Two Reports on Social Risk Factors in Medicare’s Performance Programs

    Len Marquez, Senior Director, Government Relations

    The Office of the Assistant Secretary for Planning and Evaluation (ASPE) Dec. 21 released the first of two reports to analyze the effect of social risk factors on Medicare quality-based payment programs and quality and resource use measures.

    The reports are mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 and outline three key strategies to promote quality and value, incentivize reductions in disparities, and avoid inappropriately penalizing providers that care for beneficiaries with social risk factors:

    • Measure and Report Quality for Beneficiaries with Social Risk Factors;

    • Set High, Fair Quality Standards for All Beneficiaries; and

    • Reward and Support Better Outcomes for Beneficiaries with Social Risk Factors.

    ASPE noted that patients with social risk factors had worse outcomes on quality measures in the Medicare performance and penalty programs, including the Hospital Readmissions Reduction Program and the Hospital Value Based Purchasing Program.

    ASPE also found that providers who disproportionately serve patients with social risk factors are more likely to have worse performance on these measures, even when accounting for patient mix.

    The second report will examine social risk factors that are not currently available in Medicare data (i.e. health literacy, limited English proficiency, and Medicare beneficiary activation). Additional studies also may examine functional status or frailty on the relationship between social risk factors and performance, and care innovations to achieve good health outcomes for beneficiaries with social risk factors.