Time for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame Shift
Authors: Krisda H. Chaiyachati, Jay Bhatt, Jane M. Zhu
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions3 April 2018Time for Value-Based Payment Models to Adopt a Disparities-Sensitive Frame ShiftKrisda H. Chaiyachati, MD, MPH, MSHP, Jay Bhatt, DO, MPH, MPA, and Jane M. Zhu, MD, MPPKrisda H. Chaiyachati, MD, MPH, MSHPThe Perelman School of Medicine at the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (K.H.C.)Search for more papers by this author, Jay Bhatt, DO, MPH, MPAAmerican Hospital Association and Feinberg School of Medicine at Northwestern University, Chicago, Illinois (J.B.)Search for more papers by this author, and Jane M. Zhu, MD, MPPThe Perelman School of Medicine and National Clinician Scholars Program at the University of Pennsylvania, Philadelphia, Pennsylvania (J.M.Z.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2590 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail More than 1500 hospitals recently signed the American Hospital Association's 123forEquity pledge and have begun implementing strategies to address economic and racial disparities in health care provision and outcomes. Despite these institutional commitments to equity, evidence suggests that the current growth in value-based payment models may counter these efforts, unintentionally worsening health care disparities by disadvantaging hospitals caring for socially at-risk populations (1). Because alternative payment models account for a mounting proportion of payments, equity will remain elusive unless explicitly incorporated into what we measure and pay for in health care.How can we move toward universal high performance standards ...References1. National Academies of Sciences, Engineering, and Medicine. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors. Washington, DC: National Academies Pr; 2016. Google Scholar2. Krumholz HM, Bernheim SM. Considering the role of socioeconomic status in hospital outcomes measures [Editorial]. Ann Intern Med. 2014;161:833-4. [PMID: 25437411]. doi:10.7326/M14-2308 LinkGoogle Scholar3. Keyhani S, Myers LJ, Cheng E, Hebert P, Williams LS, Bravata DM. Effect of clinical and social risk factors on hospital profiling for stroke readmission: a cohort study. Ann Intern Med. 2014;161:775-84. [PMID: 25437405]. doi:10.7326/M14-0361 LinkGoogle Scholar4. Lipstein SH, Dunagan WC. The risks of not adjusting performance measures for sociodemographic factors. Ann Intern Med. 2014;161:594-6. [PMID: 25048401]. doi:10.7326/M14-1601 LinkGoogle Scholar5. Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161:765-74. [PMID: 25437404]. doi:10.7326/M13-2946 LinkGoogle Scholar6. Ash AS, Mick EO, Ellis RP, Kiefe CI, Allison JJ, Clark MA. Social determinants of health in managed care payment formulas. JAMA Intern Med. 2017;177:1424-30. [PMID: 28783811] doi:10.1001/jamainternmed.2017.3317 CrossrefMedlineGoogle Scholar7. Mendelson A, Kondo K, Damberg C, Low A, Motúapuaka M, Freeman M, et al. The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Ann Intern Med. 2017;166:341-53. [PMID: 28114600]. doi:10.7326/M16-1881 LinkGoogle Scholar8. Boccuti C, Casillas G. Aiming for Fewer Hospital U-turns: the Medicare Hospital Readmission Reduction Program. The Henry K. Kaiser Family Foundation Issue Brief. Menlo Park, CA: The Henry K. Kaiser Family Foundation; 10 March 2017. Accessed at www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program on 11 February 2018. Google Scholar9. Colbert J, Kocot S, Brenner R, Monterastell IM, Seidman J, White R. Adopting Accountable Care: An Implementation Guide for Physician Practices. Washington, DC: The Brookings Institution; November 2014. Google Scholar10. Office of the Surgeon General; Center for Mental Health Services; National Institute of Mental Health. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001. Google Scholar Author, Article, and Disclosure InformationAffiliations: The Perelman School of Medicine at the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (K.H.C.)American Hospital Association and Feinberg School of Medicine at Northwestern University, Chicago, Illinois (J.B.)The Perelman School of Medicine and National Clinician Scholars Program at the University of Pennsylvania, Philadelphia, Pennsylvania (J.M.Z.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2590.Corresponding Author: Krisda H. Chaiyachati, MD, MPH, MSHP, 423 Guardian Drive, 13th Floor Blockley Hall, Philadelphia, PA 19104; e-mail, [email protected]edu.Current Author Addresses: Drs. Chaiyachati and Zhu: 423 Guardian Drive, 13th Floor Blockley Hall, Philadelphia, PA 19104.Dr. Bhatt: 155 North Wacker Drive, Suite 400, Chicago, IL 60606.Author Contributions: Conception and design: K.H. Chaiyachati, J. Bhatt, J.M. Zhu.Drafting of the article: K.H. Chaiyachati, J. Bhatt, J.M. Zhu.Critical revision of the article for important intellectual content: K.H. Chaiyachati, J. Bhatt, J.M. Zhu.Final approval of the article: K.H. Chaiyachati, J. Bhatt, J.M. Zhu.Administrative, technical, or logistic support: K.H. Chaiyachati, J.M. Zhu.This article was published at Annals.org on 27 February 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySocioeconomic and Racial Determinants of Brachytherapy Utilization for Cervical Cancer: Concerns for Widening DisparitiesPerpetuation of Inequity: Disproportionate Penalties to Minority-serving and Safety-net Hospitals Under Another Medicare Value-based Payment Model 3 April 2018Volume 168, Issue 7Page: 509-510KeywordsHealth careHealth disparitiesMedical risk factorsMedicareMotivationPopulation statisticsPsychiatry and mental healthResidencyRural areas ePublished: 27 February 2018 Issue Published: 3 April 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...