Accounting for Social Risk Factors in Medicare Payment Data (2016) / Chapter Skim
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2 Potential Data Sources
2 Potential Data Sources
Pages 23-34
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could include in quality measurement and payment, criteria to identify these factors, and methods to do so. For CMS to account for social risk factors in Medicare quality measurement and payment programs using these approaches, it is logical that it must first have accurate data on the social risk factors of Medicare beneficiaries.
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NEW AND EXISTING SOURCES OF CMS DATA CMS possesses a variety of data sources, some of which include data on social risk factors of Medicare beneficiaries. Existing sources of social risk factor data include administrative records and surveys of enrollees and patients.
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(These barriers are discussed in more detail in the section on other government data sources.) At the same time, using CMS data on social risk factors in quality measurement and payment programs is not without challenges.
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Although the purpose of that report was to identify social and behavioral domains that should be captured in EHRs to enhance patient care by capturing information important to providers in providing health care, there is some overlap between the social risk factors listed in this earlier IOM report and those identified in the committee's third report. Moreover, although the tasks for the two committees and the resulting two reports diverge, application of EHR data in Medicare performance measurement and payment can be considered another form of meaningful use and such application provides additional rationale for incentivizing widespread adoption of standardized collection and reporting of data from EHRs to CMS, including social risk factor data.
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Second, collecting social risk factor data through EHRs could increase burdens on individual providers and health care organizations, as well as on patients. Adding social risk factors to EHRs may require software upgrades or additional programming; modifying workflows of the clinical team to collect, enter, and manage social risk factor data in the EHR; educating providers on data collection methods to ensure accurate data; ensuring data storage systems and methods to share social risk factor data with other providers and administrators or researchers are secure; and, in some cases, intervening on or otherwise addressing social risk factors through tailored care approaches or referring patients to social service or public health agencies or community organizations that can address unmet social needs (IOM, 2014)
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(Note this includes other agencies within HHS.) These data include data that could be linked to Medicare beneficiary data at the individual level, area-level data that could be used to describe a Medicare beneficiary's residential environment or serve as a proxy for individual effects, and data that could help CMS to determine how to elicit information on social risk factors from Medicare beneficiaries.
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The small sample sizes of older adults in most census tracts would result in considerable imprecision. Data from Other National Surveys Other national surveys could be useful to CMS to determine how best to elicit information from Medicare beneficiaries on their social risk factors, because they capture substantial information on social risk factors and may offer guidance on the potential measurement strategies -- both new or alternative ways -- for many of the social risk factors that CMS could include in Medicare quality measurement and payment.
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. These specific data sources for individual social risk factor indicators and the committee's recommendations are described in the next chapter.
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2016. Accounting for social risk factors in Medicare payment: Criteria, factors, and methods.
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2016a. Non-federal acute care hospital electronic health record adoption.
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-- Medicare linked data. https://www.resdac.org/cms-data/files/nhats (accessed August 4, 2016)
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