Identification of Hospitals That Care for a High Proportion of Patients With Social Risk Factors

Abstract

IMPORTANCE Hospitals can face significant clinical and financial challenges in caring for patients with social risk factors. Currently the Hospital Readmission Reduction Program stratifies hospitals by proportion of patients eligible for both Medicare and Medicaid when calculating payment penalties to account for the patient population. However, additional social risk factors should be considered. OBJECTIVE To evaluate 7 different definitions of social risk and understand the degree to which differing definitions identify the same hospitals caring for a high proportion of patients with social risk factors. DESIGN, SETTING, AND PARTICIPANTS Across 18 publicly reported Centers for Medicare &Medicaid Services (CMS) hospital performance measures, highly disadvantaged hospitals were identified by the the proportion of patients with social risk factors using the following 7 commonly used definitions of social risk: living below the US poverty line, educational attainment of less than high school, unemployment, living in a crowded household, African American race (as a proxy for the social risk factor of exposure to racism), Medicaid coverage, and Agency for Healthcare Research and Quality index of socioeconomic status score. In this cross-sectional study, social risk factors were evaluated by measure because hospitals may serve a disadvantaged patient population for one measure but not another. Data were collected from

Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective

“…At present, there is no single consensus definition that is used in policymaking or research and each definition has inherent strengths and shortcomings [2]. Some possible definitions include facilities that are publicly owned, those that provide uncompensated or charity care, or those with a high caseload of Medicaid and uninsured; few incorporate external social risk scores [3][4][5] (see Figure 1). One commonly used definition in research is the Medicare Disproportionate Share Hospital (DSH) index, calculated with data obtained from the Centers for Medicare & Medicaid Services cost reports.…”

Interoperability among hospitals treating populations that have been marginalized

“…Yet a digital divide related to the patient population that hospitals treat has not been systematically demonstrated. Many empirical approaches exist to identify hospitals that disproportionately treat patients that have been economically and socially marginalized, and each approach identifies a different set of hospitals 15–17 . Without evidence to guide which approach to select, efforts to support engagement in interoperability may not reach hospitals with the greatest need.…”

“…Policy makers may rely on proxy measures related to their programs, such as Medicaid caseload, Medicare Disproportionate Share Hospital (DSH) Index, Uncompensated Care burden, and Critical Access Hospital (CAH) designation to target supportive policies. For instance, past policy initiatives have leveraged these measures to reach hospitals including the Centers for Medicare & Medicaid Services (CMS) State Innovation Models and the Office of the National Coordinator for Health Information Technology's regional extension centers program 14,15 . Most prominently, the Medicaid component of the Electronic Health Record Incentive Program, which ended in 2021, allowed for additional incentive payments to hospitals that served at least 10% of Medicaid case volume 16 .…”

“…Many empirical approaches exist to identify hospitals that disproportionately treat patients that have been economically and socially marginalized, and each approach identifies a different set of hospitals. 15 , 16 , 17 Without evidence to guide which approach to select, efforts to support engagement in interoperability may not reach hospitals with the greatest need. For example, the use of urban–rural location as a proxy for the treatment of populations that have been marginalized in rural areas may overlook differences in interoperability among hospitals that treat more patients that have been marginalized regardless of location.…”

“…For instance, past policy initiatives have leveraged these measures to reach hospitals including the Centers for Medicare & Medicaid Services (CMS) State Innovation Models and the Office of the National Coordinator for Health Information Technology's regional extension centers program. 14 , 15 Most prominently, the Medicaid component of the Electronic Health Record Incentive Program, which ended in 2021, allowed for additional incentive payments to hospitals that served at least 10% of Medicaid case volume. 16 While these measures capture important information about the insurance status of the patients that hospitals serve, they each identify unique hospitals and may not capture broader social dynamics related to the extent to which the populations hospitals serve have been marginalized.…”