Socioeconomic risk-adjustment with the Area Deprivation Index predicts surgical morbidity and cost

Michaels, Alex D.; Meneveau, Max O.; Hawkins, Robert B.; Charles, Eric J.; Mehaffey, J. Hunter

doi:10.1016/j.surg.2021.02.016

Cited by 48 publications

(23 citation statements)

References 15 publications

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“…As patient level geographic data are unavailable, we use the practice location as a surrogate for the neighborhood socioeconomic need. ADI as a measure of socioeconomic need has previously been applied to surgical risk adjustment and burn severity risk prediction …”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Byrd

Chung

2021

JAMA Surg

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eaching hospitals, safety-net hospitals, and large hospitals are most likely to receive penalties under the Medicare Hospital Readmissions Reduction Program. 1 However, research suggests that adjusting for patients with low incomes would decrease the penalty for half of the analyzed hospitals. 2 This situation will persist in value-based payment initiatives if appropriate risk adjustment is not incorporated. After implementation of the US Centers for Medicare & Medicaid Services (CMS) value-based program, the Merit-Based Payment System (MIPS), a national survey of internal medicine physicians found that only 8% of physicians were familiar with its measures and incentives. On clarification of the metrics, 60% of respondents felt that MIPS would encourage physicians to avoid certain disadvantaged patients to improve metrics. 3 To date, few studies focus on the value-based care systems and surgeons and surgical patients. 4,5 Implementation of value-based care measures in the absence of adjustment for social risk has the potential to unfairly penalize surgeons serving populations at high social risk. Of 510 000 clinicians participating in the first year of MIPS implementation, those with patient caseloads in the highest quintile of social risk had a lower MIPS performance score than those in the lowest social risk quintile. 6 The MIPS scores can range from 0 to 100. For the first year, a score of less than 3 led to negative payment adjustment; a score of greater than 3 but less than 70 to a posi-IMPORTANCE The latest step in the Centers for Medicaid & Medicare transformation to pay-for-value is the Medicare Merit-Based Incentive Payment System (MIPS). Value-based payment designs often do not account for uncaptured clinical status and social determinants of health in patients at high social risk, and the consequences for clinicians and patients associated with their use have not been explored. OBJECTIVE To evaluate MIPS scoring of surgeons caring for patients at high social risk to determine whether this implementation threatens disadvantaged patients' access to surgical care. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of US general surgeons participating in MIPS during its first year in outpatient surgical practices across the US and territories.

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Section: Discussionmentioning

confidence: 99%

“…ADI as a measure of socioeconomic need has previously been applied to surgical risk adjustment and burn severity risk prediction. 37,38…”

Section: Limitationsmentioning

confidence: 99%

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Byrd

Chung

2021

JAMA Surg

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“…More granular measures of socioeconomic status exist, such as the Area Deprivation Index (which uses a 9-digit zip code for score assignment). 46 However, the California Office of Statewide Health Planning and Development data set is limited to the 5-digit zip code, thus limiting our ability to use more granular indices. Nonetheless, the DCI has been shown to have clinical and economic relevance in other settings.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, there are limitations to using the DCI as a measure of economic status—namely, it is based on the patient’s 5-digit zip code, which is associated with postal delivery and therefore may not be a homogenous community. More granular measures of socioeconomic status exist, such as the Area Deprivation Index (which uses a 9-digit zip code for score assignment) . However, the California Office of Statewide Health Planning and Development data set is limited to the 5-digit zip code, thus limiting our ability to use more granular indices.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Procedures Among Adults Discharged to Hospice After Gastrointestinal Tract Surgery in California

et al. 2022

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IMPORTANCE Hospice care is associated with improved quality of life and goal-concordant care.Limited data suggest that provision of hospice services after surgery is suboptimal; however, literature in this domain is in its nascency, leaving gaps in our understanding of patients who enroll in hospice after surgery.OBJECTIVE To characterize the transition to hospice after gastrointestinal tract surgery and identify areas that warrant further attention and intervention. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included patients discharged to hospice after a surgical hospitalization for a digestive disorder in California-licensed

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“…Measures of social and community stress exist to quantify environmental stressors of population health that have trickle down effects on individual patient outcomes. Lack of community resources, crime-related vulnerability [ 1 ], and economic deprivation assigned to individual regions within the USA using validated scales have been associated with increased mortality following trauma-related injury [ 2 , 3 ], premature mortality [ 4 ], and increased surgical morbidity and cost [ 5 , 6 ]. Moreover, measures of community distress have been independently associated with postoperative complications and readmission following surgery [ 6 ].…”

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confidence: 99%

Community distress as a predictor of early hernia recurrence for older adults undergoing ventral hernia repair (VHR)

et al. 2022

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Background Social cohesion and neighborhood support have been linked to improved health in a variety of fields, but is not well-studied among the elderly population. This is particularly evident in surgical populations. Therefore, this study sought to assess the potential role of community distress in predicting early hernia recurrence among older adults. Methods The Abdominal Core Health Quality Collaborative (ACHQC) was used to identify patients aged 65 or older undergoing elective ventral hernia repair with zip code data available. Patients were linked to the Distressed Communities Index (DCI), which is a national database that assigns a score of 0–100 to each zip code based on 7 measures of neighborhood prosperity. Quintiles were used to compare groups: prosperous (0–20), comfortable (21–40), mid-tier (41–60), at-risk (61–80), and distressed (81–100). Distressed (0–20), at-risk (21–40), mid-tier (41–60), comfortable (61–80), and prosperous (81–100). Time to recurrence for neighborhood distress quintiles was examined using a Cox proportional hazards model. Results In total, 9819 patients were included in the study, including 3056 (31.1%) prosperous, 2307 (23.5%) comfortable, 1795 (18.2%) mid-tier, 1390 (14.2%) at-risk, and 1271 (12.9%) distressed. Distressed communities had lower mean age and greater proportion of racial minorities ( p < 0.001). Open repairs were significantly more common among the distressed group (66.7%), as were all comorbidities ( p < 0.001). Recurrence-free survival was shorter for distressed communities compared to prosperous after adjusting for baseline characteristics (HR 1.3, 95% CI 1.07–1.67, p = 0.01). Mean time to recurrence was lowest for patients living in distressed communities, indicating the worst recurrence rates, while mean time to recurrence was greatest for those in prosperous zip codes ( p < 0.001). Conclusion Older VHR patients presenting from distressed zip codes, as identified by the Distressed Communities Index, experience hernia recurrence significantly sooner as compared to patients from prosperous zip codes. This study may provide evidence of the role of neighborhood and environmental factors in caring for older patients following VHR. Graphical abstract

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Socioeconomic risk-adjustment with the Area Deprivation Index predicts surgical morbidity and cost

Cited by 48 publications

References 15 publications

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Characteristics and Procedures Among Adults Discharged to Hospice After Gastrointestinal Tract Surgery in California

Community distress as a predictor of early hernia recurrence for older adults undergoing ventral hernia repair (VHR)

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