News: Hospitals may be penalized for serving disadvantaged patients, study says

CDI Strategies - Volume 14, Issue 2

Hospitals who serve disadvantaged patients in vulnerable communities may be unfairly penalized by the CMS rating system, according to an analysis released by the University of Chicago Medicine, HealthLeaders Media reported.

The CMS rating system, according to the study, does not account for social risk factors (SRF) and as a result, provider organizations could be judged on "social factors outside of their control." Researchers found that in an analysis of more than 3,600 hospitals across the country, those that provide care in neighborhoods with higher social risks achieved lower quality scores from CMS. 

Hospitals are likely to be judged, and potentially penalized, based on geographic location, Elizabeth Tung, MD, MS, lead author of the study, said.

“Living in a disadvantaged community can influence health directly through social factors like substandard housing conditions, inadequate access to food or transportation, and high levels of stress due to safety concerns," Tung said in a statement. "These factors work against well-being, so patients from these neighborhoods have more barriers to health to begin with.”

The study found that hospitals in disadvantaged neighborhoods lagged in scores for timeliness of care, largely a measure of emergency room wait times, and hospital readmissions, according to HealthLeaders Media. Researchers said, however, that safety, efficiency, and effectiveness of care were "minimally affected" by SRFs.

Hospitals have criticized CMS' Overall Hospital Quality Star Ratings since the system was put into place in 2016, often calling for major changes or elimination of the program.

Last February, the rating system was updated for the first time since 2017 and in August, CMS announced plans to "update" Star Ratings in 2021.

Editor’s note: This article originally appeared in HealthLeaders Media. An article about the last rating system update can be found here. An article on plans to update the Star Ratings in 2021 can be found here.

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