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AAMC Submits Comments on NQF Draft Report Recommending Inclusion of Sociodemographic Factors

April 18, 2014— The AAMC April 16 submitted comments  on the National Quality Forum’s (NQF) draft report on sociodemographic status factors and risk adjustment. A key recommendation would change NQF’s policy to allow sociodemographic status to be a factor in the risk-adjustment methodology for certain accountability measures [See Washington Highlights, March 21]. The draft report was produced by an NQF expert panel, which included AAMC Chief Public Policy Officer, Atul Grover, M.D., Ph.D.

The AAMC supported all eight recommendations outlined in the report. The association cited the trend in quality measurement towards the inclusion of complex outcome and resource use measures, and argued that such measures will require a more robust risk adjustment to account for factors that are outside of the provider’s control.

Additionally, the AAMC pointed to the Hospital Readmission Reduction Program (HRRP) as an example of the unintended consequences of not adjusting for sociodemographic variables in a pay-for-performance program: safety-net providers may lose scarce resources necessary to care for vulnerable patients, which potentially entrenches disparities.

The AAMC advocated for one recommendation to be strengthened. The NQF report highlighted that “users of performance measures should assess the potential impact on disadvantaged patient populations and the providers serving them to identify unintended consequences…” In its comments, the association argued that instead, users “must” assess the impact on disadvantaged populations to identify potential inequalities that may arise.

Regarding another recommendation in the report that focused specifically on how measures should be implemented in pay-for-performance programs, the AAMC stated its support and noted that NQF-endorsed measures are not always used as specified. While NQF does not enforce implementation of its measures, it needs to be clear about what an endorsed measure is and how it should be used.

The draft report is available, though the deadline for submitting comments has passed. The comments will be reviewed by the NQF expert panel in May.


Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297

Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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