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

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 April 1, 2014, to June 30, 2017, and analyzed from July 25, 2019, to April 25, 2021.
Main Outcomes and Measures: The proportion of hospitals identified as caring for patients with social risk factors using 7 definitions of social risk, across 18 publicly reported CMS hospital performance measures.
Results: Among 4465 hospitals, a mean of 31.0% (range, 28.9%-32.3%) were identified at least once when using the 7 definitions of social risk as caring for a high proportion of patients with social risk factors. Among all hospitals meeting at least 1 definition of social risk, a mean of 0.7% (range, 0%-1.0%) were identified as highly disadvantaged by all 7 definitions. Among hospitals meeting at least 1 definition of social risk, a mean of 2.7% (range, 1.3%-5.1%) were identified by 6 definitions; 6.5% (range, 5.9%-7.1%), by 5 definitions; 10.4% (range, 9.5%-12.1%), by 4 definitions; 13.2% (range, 10.1%-14.4%), by 3 definitions; 21.4% (range, 20.1%-22.4%), by 2 definitions; and 45.2% (range, 42.6%-47.1%), by only 1 definition. This pattern was consistent across all 18 performance measures.
Conclusions and Relevance: In this cross-sectional study, there were inconsistencies in the identification of hospitals caring for disadvantaged populations using different definitions of social risk factors. Without consensus on how to define disadvantaged hospitals, policies to support such hospitals may be applied inconsistently.
Competing Interests: Conflict of Interest Disclosures: Ms Matty reported receiving salary support from the Centers for Medicare & Medicaid Services (CMS) to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported. Dr Heckmann reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported, in addition to receiving research support from the FDA as part of a Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation program through Yale as part of a Centers for Disease Control and Prevention project designed to strengthen prescription drug overdose prevention efforts, from Connecticut Department of Public Health as part of a public health project designed to assess the impact of Good Samaritan Laws, and from the Community Health Network of Connecticut for her work as a medical consultant. Ms George reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported. Ms Barthel reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported. Dr Suter reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported. Dr Ross reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported; receiving research support through Yale University from Medtronic, Inc, and the US Food and Drug Administration (FDA) to develop methods for postmarket surveillance of medical devices and from the Blue Cross Blue Shield Association to better understand medical technology evaluation, through Yale University from Johnson & Johnson to develop methods of clinical trial data sharing, and from the FDA to establish the Yale–Mayo Clinic Center for Excellence in Regulatory Science and Innovation program; and receiving grants from the Medical Device Innovation Consortium as part of the National Evaluation System for Health Technology, the Agency for Healthcare Research and Quality, the National Heart, Lung and Blood Institute of the National Institutes of Health, and from the Laura and John Arnold Foundation to establish the Good Pharma Scorecard at Bioethics International and the Collaboration for Research Integrity and Transparency at Yale. Dr Bernheim reported receiving salary support from the CMS to develop, implement, and maintain hospital performance outcome measures, including those related to this report, that are publicly reported, and Humana, Inc, to advise on quality strategy.
(Copyright 2021 Matty R et al. JAMA Health Forum.)