Measuring Quality and Enacting Policy

In this issue of Circulation Cardiovascular Quality and Outcomes , Blum et al1 ask how hospital quality profiling for the 48 hospitals in New York City would change if publicly reported heart failure readmission measures accounted for patients’ socioeconomic status. This article is timely—the debate about patients’ socioeconomic status and outcome quality measures is garnering national attention, including public statements by the American Hospital Association,2 the release of an expert report commissioned by the National Quality Forum,3 and proposed legislation on the same topic, which would modify the formula used to penalize hospitals for excess readmissions to account for the low-income patients served by the hospital.4Article see p 391Sparked by concerns about impact of pay-for-performance programs on safety-net providers5,6 and fueled by data suggesting that hospitals with higher disproportionate share hospital funding face payment penalties at a greater rate under the Hospital Readmission Reduction Program,7,8 increasingly stakeholders are calling for a change to the Center for Medicare and Medicaid Services (CMS) readmission measures to include risk adjustment for patients’ socioeconomic status. The article by Blum et al,1 however, demonstrates that for a diverse set of New York City hospitals such a change would have little impact on hospital profiling.Blum et al1 use a methodological approach that closely mirrors, but is not identical to, the methods used by CMS to calculate hospitals’ 30-day risk-standardized readmission risk for patients after heart failure hospitalizations. This is a strength of the article. As with CMS’s measures, the authors’ use hierarchical modeling to compare a hospital’s performance to what would be expected for an average hospital with a similar case mix. They then simulate the effect of adding socioeconomic status to the risk model. In their evaluation of hospital profiling, …