Elizabeth Tung MD MS Section of General Internal Medicine Instructor of Medicine University of Chicago

Neighborhood Social Factors Impact Medicare Hospital Ratings

MedicalResearch.com Interview with:

Elizabeth Tung MD MS Section of General Internal Medicine Instructor of Medicine University of Chicago

Dr. Tung

Elizabeth Tung MD MS
Section of General Internal Medicine
Instructor of Medicine
University of Chicago

MedicalResearch.com: What is the background for this study?

Response: Medicare provides hospital ratings for all Medicare-certified hospitals in the U.S. based on quality metrics, including mortality, patient experience, hospital readmissions, and others. While ratings are important for comparing hospitals, there’s been some concern that some of these quality metrics are outside a hospital’s control, especially for hospitals taking care of vulnerable or socially complex patient populations. Take “timeliness of care” as a quality metric, for instance–this measure includes emergency room wait times. But in places that are medically underserved and have very few emergency rooms, these wait times will inevitably be much higher. What this means is that hospitals taking care of medically underserved populations end up getting lower quality ratings, even though they’re addressing health disparities by filling an access gap.

MedicalResearch.com: What are the main findings?

Response: Ultimately, we looked at the local catchment areas for 3,608 Medicare-certified hospitals, and measured “neighborhood social risk” for the areas covered by each hospital, including factors like median household income, educational attainment, employment, racial/ethnic composition, insurance status, and others. And what we found was that hospitals serving neighborhoods with higher social risk had lower hospital ratings.

MedicalResearch.com: What should readers take away from your report?

Response: The main takeaway is that hospitals serving communities with higher social risk may have lower ratings, not because of factors within their control, but because of neighborhood factors. Failing to account for neighborhood social risk in hospital rating systems can reinforce hidden disincentives to care for medically underserved areas. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We think that hospital rating systems should account for neighborhood social risk in their rating calculations. Risk adjustment can help–but we also recommend metrics that explicitly measure contributions to health equity. For instance, if a metric existed for “reducing access gaps,” this could offset some of the differences that stem from lower “timeliness of care” scores.

MedicalResearch.com: Is there anything else you would like to add?

Response: We appreciate that creating a fair hospital rating system is an especially challenging and daunting task. There’s incredible heterogeneity in the types of communities served by hospitals across the U.S., which makes direct comparisons extremely difficult. Thus, we think accounting for that heterogeneity–accounting for neighborhood social risk–is an incredibly important next step to making ratings systems not just more fair, but more equitable.

We have no disclosures. 


.Neighborhood Disadvantage and Hospital Quality Ratings in the Medicare Hospital Compare Program

Fahrenbach, John PhD*; Chin, Marshall H. MD, MPH†,‡; Huang, Elbert S. MD, MPH*,†,‡; Springman, Mary K. MHA*; Weber, Stephen G. MD, MPH*,§; Tung, Elizabeth L. MD, MS†,‡,∥

Medical Care: December 30, 2019 – Volume Publish Ahead of Print – Issue – p
doi: 10.1097/MLR.0000000000001283


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Last Updated on January 14, 2020 by Marie Benz MD FAAD