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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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ACCOUNTING FOR

Social Risk Factors

IN

Medicare Payment


Identifying Social Risk Factors

Committee on Accounting for Socioeconomic Status in Medicare Payment Programs

Board on Population Health and Public Health Practice

Board on Health Care Services

Institute of Medicine

images

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. HHSP233201400020B from the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-38124-6
International Standard Book Number-10: 0-309-38124-X
DOI: 10.17226/21858

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for social risk factors in Medicare payment: Identifying social risk factors. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
×

images

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
×

COMMITTEE ON ACCOUNTING FOR SOCIOECONOMIC STATUS IN MEDICARE
PAYMENT PROGRAMS

DONALD M. STEINWACHS (Chair), Professor, Johns Hopkins Bloomberg School of Public Health

JOHN Z. AYANIAN, Alice Hamilton Professor of Medicine, Director, Institute for Healthcare Policy and Innovation, University of Michigan

CHARLES BAUMGART, Senior Medical Director, xG Health Solutions

MELINDA BUNTIN, Chair, Department of Health Policy, Vanderbilt University School of Medicine

ANA V. DIEZ ROUX, Dean and Distinguished Professor of Epidemiology, Drexel University Dornsife School of Public Health

MARC N. ELLIOTT, Senior Principal Researcher, RAND Corporation

JOSÉ J. ESCARCE, Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles

ROBERT FERRER, Dr. John M. Smith, Jr. Professor, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio

DARRELL J. GASKIN, Associate Professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

MARK D. HAYWARD, Professor of Sociology, Centennial Commission Professor in the Liberal Arts, Faculty Research Associate, Population Research Center, University of Texas at Austin

JAMES S. JACKSON, Daniel Katz Distinguished University Professor of Psychology, Research Professor, Institute for Social Research, University of Michigan

DANIEL POLSKY, Executive Director, Leonard Davis Institute of Health Economics, University of Pennsylvania

MEREDITH ROSENTHAL, Professor of Health Economics and Policy, Harvard T.H. Chan School of Public Health

ANTHONY SHIH, Executive Vice President, The New York Academy of Medicine

Study Staff

KATHLEEN STRATTON, Study Director

LESLIE Y. KWAN, Associate Program Officer

EMILY VOLLBRECHT, Senior Program Assistant

REBECCA MORGAN, Senior Research Librarian

DORIS ROMERO, Financial Associate

HOPE HARE, Administrative Assistant

ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice

SHARYL NASS, Board Director, Board on Health Care Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

JACK EBELER, Independent Consultant

LEE FLEISHER, University of Pennsylvania School of Medicine

DEBORAH A. FREUND, Claremont Graduate University and RAND Corporation

PAMELA HERD, University of Wisconsin–Madison

LISA I. IEZZONI, Harvard Medical School and Massachusetts General Hospital

DAVID R. NERENZ, Henry Ford Health System

THOMAS RICE, University of California, Los Angeles, Fielding School of Public Health

JOSHUA M. SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by GEORGES C. BENJAMIN, American Public Health Association, and CHARLES E. PHELPS, University of Rochester. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Acronyms

ACA Patient Protection and Affordable Care Act of 2010
ACO accountable care organization
ADL activity of daily living
AHRQ Agency for Healthcare Research and Quality
AMI acute myocardial infarction
APM alternative payment model
BY benchmark year
CAHPS Consumer Assessment of Healthcare Providers and Systems
CAUTI Catheter-Associated Urinary Tract Infection
CDC Centers for Disease Control and Prevention
CHIP Children’s Health Insurance Program
CLABSI Central-Line Associated Bloodstream Infection
CMS Centers for Medicare & Medicaid Services
COPD chronic obstructive pulmonary disease
CY calendar year
ED emergency department
ESRD end-stage renal disease
FY fiscal year
GAO Government Accountability Office
HAC hospital-acquired condition
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Suppliers
HCC hierarchical condition categories
HF heart failure
HHS Department of Health and Human Services
HRRP Hospital Readmission Reductions Program
IADL instrumental activity of daily living
IMPACT Act Improving Medicare Post-Acute Care Transformation Act of 2014
IOM Institute of Medicine
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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IPPS Inpatient Prospective Payment System
LEP limited English proficiency
MA Medicare Advantage/Medicare Part C
MIPS Merit-Based Incentive Payment System
MedPAC Medicare Payment Advisory Commission
MIPPA Medicare Improvements for Patients and Providers Act
MLR minimum loss rate
MSPB Medicare spending per beneficiary
MSR minimum savings rate
MSSP Medicare Shared Savings Program
NHSN National Healthcare Safety Network
NQF National Quality Forum
PN pneumonia
PQRS Physician Quality Reporting System
PSA prostate-specific antigen
PSI patient safety indicator
SEP socioeconomic position
SES socioeconomic status
SNF Skilled Nursing Facility
SSI Surgical Site Infection
STEMI ST-segment elevation myocardial infarction
VA Department of Veterans Affairs
VBP value-based payment
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: The National Academies Press. doi: 10.17226/21858.
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.

Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors is the first in a series of five reports commissioned to provide input into whether socioeconomic status (SES) and other social risk factors could be accounted for in Medicare payment and quality programs. This report focuses on defining SES and other social factors for the purposes of application to Medicare quality measurement and payment programs.

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