News: More complex patients tied with higher penalties for hospitals, study says

Though addressing social determinants of health (SDOH) is a primary approach to achieving health equity, it may be costing hospitals. A significant link was found between hospital penalties and several uncontrollable factors for hospitals such as medical complexity and uncompensated care, a new study published in Health Affairs found.

One factor, the portion of patients that live alone, had a particularly strong association with hospital value-based penalties across all three of CMS’ programs (the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program). Results also showed that hospitals with less complex patients were generally less likely to receive a penalty compared to hospitals with patients with the highest complexity, HealthLeaders reported.

After gathering value-based program penalty results for a variety of hospitals across three groups, researchers assessed the impact of patient and community health equity risk factors on hospital penalties, finding a strong positive relationship.

“These environmental conditions can be worse for hospitals that operate in areas with historically underserved populations,” co-authors of the study wrote. “This suggests that the CMS programs might not adequately account for health equity factors at the community level. Refinements to these programs (including an explicit incorporation of patient and community health equity risk factors) and continued monitoring will help ensure that the programs work as intended in a fair and equitable fashion.”

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the Health Affairs study, click here. To read more about SDOH, click here.