The National Quality Forum (NQF) has released a report that provides overviews of risk adjustment in health care, the findings of which are critical for home health and hospice measures. VNAA strongly believes that unless policymakers carefully calibrate risk adjustment, a negative impact will fall on access to care for vulnerable patients, and that NQF's current policy is unintentionally weakening the network of providers that serve disadvantaged populations and worsening disparities.
On April 11, VNAA's submitted comments to NQF in a letter:
- Collection and Analysis: VNAA advocates for comprehensive study of both risk adjustment factors and quality measurement for home health and hospice across Medicare and other payers. Any studies completed must include active engagement of nonprofit providers.
- Vulnerable Patients: Appropriate risk adjustment takes into consideration sociodemographic, clinical and socioeconomic status. It is essential to address the issues that disadvantaged patients face in improving their own health, as well as the unique importance of the support needed for those receiving care in the home.
- Setting and Level of Control: There must be adequate risk adjustment for outcomes on both factors that are inherent to the setting and the level of control healthcare providers have over an outcome or process.
- Unique Home Care Setting: Peer group comparisons, such as the approach recommended by MedPAC, may be valid for acute care settings. Home health and hospice should use this method in combination with sociodemographic adjustment and considerations for the home setting.
- Consistency: There must be consistency with regard to incentives, measures, time frames and definitions so that all providers are equally committed to quality outcome measures.
VNAA also addressed socioeconomic factors in its March letter to MedPAC. View the MedPAC letter here.