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NQF Draft Recommends Including SES Factors in Certain Accountability Measures

March 21, 2014— The National Quality Forum (NQF) March 18 released a draft report on socioeconomic status (SES) factors and risk adjustment.  A key recommendation, if finalized, would change NQF’s policy to allow SES to be a factor in the risk-adjustment methodology for certain accountability measures.  The report was produced by an NQF expert panel of 26 individuals representing a diverse group of stakeholders, including AAMC Chief Public Policy Officer Atul Grover, M.D., Ph.D.

Most panel members voted in favor of the eight recommendations listed in the report. The first recommendation in the report distinguishes risk adjustment for purposes of accountability versus identifying and reducing disparities. The second recommendation notes that for accountability measures, risk adjustment can include both socio-demographic as well as clinical factors, assuming those factors are not mitigated by the quality of care.

Other recommendations focus on the guidelines for selecting risk adjustment factors, the type of information that is available, and other related factors, such as guidance on how measures should be implemented.

Outcomes measures are typically adjusted to account for differences in patient health status and clinical factors (e.g., severity of illness and co-morbidities), but not SES. The NQF’s current position was based on the concern that including SES would mask disparities among providers, and would ultimately create lower standards of performance for those serving disadvantaged populations.

The expert panel, however, identified other consequences: a lack of SES adjustment in pay for performance programs could harm patients by leading to greater disparities in care and fewer resources for safety net providers to treat disadvantaged populations. Examples of SES indicators include income, race, English proficiency, and education; however, the panel did not make specific recommendations as to which factor(s) should be used for a measure adjustment.

The AAMC has advocated for certain measures, particularly those relating to readmissions and Medicare Spending per Beneficiary, to be adjusted for SES factors in order to improve the accuracy of performance results [see Washington Highlights, Feb. 28].

Public comment on the full report can be submitted through the NQF project page until 6 p.m. EDT on April 16, 2014.


Len Marquez
Director, Government Relations
Telephone: 202-862-6281


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