The Center for Health Information and Analysis (CHIA) and Massachusetts Health &  Hospital Association (MHA) have released of a report detailing proposed solutions to account for social risk factors in the public reporting of all-payer, unplanned hospital readmissions. CHIA reports regularly on unplanned hospital readmissions; however, recent national research provides evidence that social risk factors should be accounted for in the measurement of hospital performance. 

In response to  the emerging consensus regarding the effect of social risk factors  on hospital performance, CHIA convened a workgroup of representatives from state agencies, hospitals and health systems, provider and payer groups, and methodology experts to discuss if, and how, to account for social risk factors in their readmissions work. MHA co-chaired this statewide workgroup.

Collaborating with sister state agencies, hospitals and other parties, CHIA developed an enhanced risk-adjustment model for its all-payer readmissions analysis. The enhanced model includes patient- and community-level risk factors, such as poverty, education, housing, and food insecurity. In a preliminary analysis, readmission rates of hospitals serving a high proportion of Medicare and Medicaid patients declined more than any other hospital cohort, from 16.5% to 16.3%. 

“There is a growing body of evidence that social risk factors influence access, utilization, and quality of healthcare,” said MHA Vice President for Clinical Affairs Patricia Noga, R.N., Ph.D., FAAN.  “MHA is proud to have co-chaired the Statewide Workgroup on Social Risk Factors with CHIA to consider how these factors may affect hospital readmissions, and to recommend possible best practice adjustments to performance reporting as a result. It’s important to understand the challenges hospitals face that are beyond their control, and to learn from those facilities that successfully reduce readmissions despite these challenges.”

The workgroup’s recommendations are consistent with national trends. CMS recently began accounting for social risk factors in its Hospital Readmissions Reduction Program by accounting for the proportion of dually eligible Medicare and Medicaid patients when assessing hospital performance. Dual eligibility is often an indicator of poor socioeconomic conditions.

CHIA plans to undergo a pilot phase with select hospitals to field questions and obtain additional feedback prior to implementing the recommended changes statewide. This enhanced methodology will be incorporated into CHIA’s next annual readmissions report.

“Adjusting for social risk factors will allow for more equitable comparisons of readmission rates, which are increasingly being viewed as a performance measure of a hospital or health system,” said Ray Campbell, CHIA’s executive director. “Incorporating the recommendations from the workgroup will be an important addition to CHIA’s reporting on readmissions and thank you to MHA for their partnership in this process.”

For more information, please visit http://www.chiamass.gov/hospital-wide-adult-all-payer-readmissions-and-revisits-in-massachusetts/. 

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About CHIA:

The Center for Health Information and Analysis (CHIA) is an independent state agency charged with monitoring the performance Massachusetts health care system. CHIA’s mission is to be the agency of record for Massachusetts health care information, to responsibly steward sensitive and confidential data, and to objectively report reliable and meaningful information about the quality, affordability, utilization, access, and outcomes of the Massachusetts health care system.

About the Massachusetts Health & Hospital Association (MHA):

The Massachusetts Health and Hospital Association (MHA) was founded in 1936, and its members include 70 licensed member hospitals, many of which are organized within 29 member health systems, as well as interested individuals and other healthcare stakeholders. MHA serves as the unified voice for Massachusetts hospitals on Beacon Hill and Capitol Hill. Through leadership in public advocacy, education, and information, MHA represents and advocates for the collective interests of its members and supports their efforts to provide high-quality, cost-effective, and accessible care during an era of unprecedented change.