Dr Ashish K. Jha on Socioeconomic Status in CMS Star Ratings

Accounting for socioeconomic status in risk adjustment can avoid penalizing hospitals with more low-income patients, according to Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Transcript (slightly modified)

Why do you think CMS did not factor in the economic well-being of patients as part of the Medicare star ratings program for hospitals? What’s the argument for including that into the rating system?

So there’s been this, I think at times really misguided, debate between some people who think we shouldn’t be adjusting for socioeconomic status, because their argument is that somehow that’s giving hospitals credit for providing bad care to poor people. I think that’s just a misunderstanding of how risk adjustment works. We do risk adjustment, when we do risk adjustment we account for age, but we’re not saying we’re going to give hospitals credit for providing bad care to older people.

What you want to do is—it’s fine to penalize hospitals that provide bad care to poor people, we just don’t want to be penalizing hospitals that take care of more poor people. So if 2 organizations are exactly the same in terms of how well they do for their poor patients, but one hospital has twice as many poor patients as the other, you don’t want to penalize that hospital just because they have more poor people. That’s what the risk adjustment, or the lack of risk adjustment, for socioeconomic status is doing. And I think there are some people within CMS, the people who’ve developed the measures, who have just misunderstood this issue, and I think are really fixated on this idea that we’d be creating 2 different standards of care, which is not necessarily the case.