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Wednesday, 11 April, 2018

The Problem with Peer Grouping when Adjusting for SES in Calculating Readmission Penalties

In May of 2017 Dr. Graham Atkinson, the Foundation’s EVP for Research and Policy, wrote a paper arguing that the use of peer groups to adjust for socio-economic status (SES) in the calculation of hospital readmission penalties, while it was better than having no adjustment for SES, was not the best approach, and suggested a better approach based at the patient level. Unfortunately, MedPAC recommended, Congress mandated, and CMS implemented the use of the peer group approach to SES adjustment.

Richard Fuller and other researchers at 3M Health Information Systems recently published in The Joint Commission Journal on Quality and Patient Safety an analysis that demonstrates and quantifies problems associated with the use of peer grouping for this purpose, and advocated the method suggested by Dr. Atkinson.  The article and related editorial are available online with open access.

We hope that this thoughtful paper will result in some rethinking of how to adjust for differences in SES in the readmission, and other quality measurement areas.

Search Tags: SES , Medicare , Readmissions

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