MedicalResearch.com Interview with:
Marion R. Sills, MD, MPH
Associate Professor, Departments of Pediatrics and Emergency Medicine
University of Colorado School of Medicine
Medical Research: What is the background for this study?
Dr. Sills: My co-authors and I know that studies show that patients who are poorer or are minorities are readmitted at higher rates than other patients, and that readmissions penalties, which are far more commonly applied in relation to readmissions of adult patients, have been shown to punish hospitals for the type of patients that they serve, rather than purely for the quality of care they provide. Currently, these penalties impact hospitals treating Medicare patients in all 50 states but only impact readmissions of children in 4 states, although other states are considering implementing these penalties. This was our rationale for exploring the impact of patients’ social determinants of health (factors like race, ethnicity, health insurance and income) on how likely it was that a hospital would be penalized for readmissions under a typical state-level pay-for-performance measure based on hospital readmissions. Readmissions penalties are designed to penalize hospitals that provide lower quality care. However, without adjusting for social determinants of health factors, these pay-for-performance measures may unfairly penalize hospitals based on the type of patient they treat as well as the quality of care they provide.
Medical Research: What are the main findings?
Dr. Sills: We found that risk adjustment for social determinants of health factors changed hospitals’ penalty status on a readmissions-based pay-for-performance measure. Without adjusting the pay-for-performance measures for social determinants of health, hospitals may receive penalties partially related to patient factors beyond the quality of hospital care.
Medical Research: What should clinicians and patients take away from your report?
Dr. Sills: The bottom line is more relevant to policy-makers: namely, without adjusting for social determinants of health factors, pay-for-performance measures designed to penalize lower-quality care may unfairly penalize hospitals based on the type of patient they treat.
For patients I would say that some of the hospital-level performance measures you see may reflect factors in addition to the quality of care delivered. Some performance measures are more impacted by social determinants of health than others.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Sills: It is important to do further work to characterize the effects of social determinants of health on performance measures as this work may assist efforts to improve care quality and deliver more equitable care. Further research to measure which social determinants are most predictive of outcomes is also important, as these measures are costly to collect, and also not so popular with patients (for example, patients sometimes do not like selecting which ethnicity they are or stating their income). So, if we can show which factors are most important to collect, we can help improve the quality and completeness of the data we use to risk-adjust performance measures.
Medical Research: Is there anything else you would like to add?
Dr. Sills: In general, this adds to the literature showing that although it is vitally important to measure the quality of care, sometimes this measurement, if not done fairly, can have negative and major consequences. Safety net hospitals often have a narrow operating margin, and they are the most vulnerable to penalties like this based on the poverty and access to care of the patients they serve. Further penalizing the most under-resourced hospitals may widen disparities of care rather than narrowing them.
Marion R. Sills, MD, MPH (2016). Social Factors Impact Children’s Hospitals’ Readmissions MedicalResearch.com