Panel: Medicare's 'quality' metrics penalize hospitals serving poor areas

Apr 30 2014

Federal pay-for-performance programs should take into account patients' income, race and other factors when deciding how to reward or penalize hospitals, the panel's recommendations say.

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The CMS should change current policy that may unfairly penalize providers who serve primarily low-income patients, the National Quality Forum says in a recent report. The NQF recommends including patient income, race and other factors in using quality measurements to assess provider performance and what providers are paid (Dickson, 4/28).

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Federal policies intended to improve the quality of health care may unfairly penalize hospitals that serve low-income people -- shifting money away from doctors at these facilities and further widening the disparity between the rich and poor. That is the concern of a panel of 26 experts commissioned by the Obama administration that is calling for a sweeping overhaul to federal pay-for-performance initiatives. Medicare and a growing number of private insurance companies are paying providers based on their performance as measured by patient outcomes. The whole idea is to reward quality care and get away from the old fee-for-service model However, the expert panel, created by the National Quality Forum, said in a draft report first obtained by The New York Times that the current approach is severely flawed because it does not take into account the socioeconomic status of patients at each hospital (Ehley, 4/28).