Should Performance Metrics be Adjusted for Socioeconomic Status (SES)?

According to a recent draft report from the National Quality Forum (NQF) (see Draft Report for Commenting ):

“There is a concern that NQF’s current policy to not adjust performance measures for sociodemographic factors results in incorrect conclusions about quality. Coupled with use of performance measures for accountability, this could lead to greater disparities in care, due to disadvantaged populations losing access to care as providers become more hesitant to treat them. There is also concern that without proper adjustments, safety net providers may have fewer resources to treat disadvantaged populations. Therefore, the Expert Panel is recommending changes to NQF’s measure evaluation criteria and guidance for which NQF is seeking public comment. Ultimately, the goal of this work is to help the healthcare community reduce disparities in care, while simultaneously drawing accurate conclusions about the quality of care rendered.”

NQF has more details about these recommendations on their web site.  But what is clear from the report is that how we measure is as important as the metrics.  It might be much harder than was original thought to measure performance and that is certainly the case when front line doctors are excluded from the process.

As reimbursement rates are increasingly tied to performance metrics there is more at stake for safety net hospitals.  According to Kaiser Health News more safety net hospitals were penalized for high readmission rates:

 “Among the safety net hospitals with the most poor patients, 77 percent were penalized, while only 36 percent of the hospitals with the fewest poor patients were penalized. Denver Health Medical Center, which has historically had low readmission rates and thus has been cited as proof that safety net hospitals can avoid readmissions for their patients, will get a 0.04 percent penalty after avoiding any punishment last year.”

The whole question of how to fairly measure performance is becoming a bigger issue in Washington according.  At Doctor Council hospitals we often hear stories of inappropriate measurement, or cases in which a department is held to a standard that does not take into account SES data.  Please send us your stories about performance measurements and SES.