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  • Washington Highlights

    National Academy of Sciences Releases Report on Socioeconomic Status in Medicare Payment Programs

    Len Marquez, Senior Director, Government Relations

    The National Academies of Sciences, Engineering, and Medicine (NAS) October 11 released the fourth in a series of five reports focused on accounting for socio risk factors in Medicare payments [see Washington Highlights, July 15]. In this report, the NAS recommends either existing or new sources of data on socioeconomic (SES) factors, highlights strategies for collecting this data, and identifies challenges to obtaining appropriate data. The reports are mandated by Congress as part of Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act, P.L. 113-185).

    This report reviews data sources and data collection strategies to account for social risk factors in Medicare’s value based payment program. The report highlights three categories of data sources and provides recommendations to address challenges in collecting this information:

    • New and existing data collected by the Centers for Medicare and Medicaid Services (CMS);

    • Data from health care providers and health plans; and

    • Alternative government data sources, including national surveys that non-CMS federal agencies and state agencies oversee and maintain.

    CMS currently does not adjust Medicare performance programs to account for social risk factors. Providers have long expressed concerns that not accounting for these factors may disproportionately disadvantage those institutions that serve vulnerable patient populations.

    Previous NAS reports focused on defining SES, identifying SES factors that impact health outcomes, and identifying best practices of high-performing providers and health plans that disproportionately serve disadvantaged patient populations. The final report, expected in early 2017, will synthesize all of the reports and will include additional recommendations.