Consensus Group Mulls Measure Adjustment

In a potential major policy change, the Washington DC-based National Quality Forum (NQF) is considering whether to recognize socioeconomic risk adjustments to the outcomes measures it endorses. Traditionally, NQF has taken the position that including health status risk factors in measuring outcomes runs the risk of rationalizing poor performance, and/or “masking disparities” by permitting different providers to be held to different performance standards. But in a draft report released for comment in mid-March, NQF asked for comment on a change in policy that would permit risk adjustment for certain quality measures. With quality measure results increasingly being used to adjust payments to providers, NQF posits that absent risk adjustment for health status “the results of such unrealistic demands may be fewer and fewer providers willing to serve the already underserved.” NQF asked for comment on whether risk adjustment should be used to account for such issues as poverty, low literacy, limited English-language proficiency, homelessness and lack of support resources. Comments on the draft were sharply divided, according to Modern Healthcare, with providers arguing such adjustments are long overdue and some consumer groups arguing a lack of documentation that the absence of risk adjustments has caused actual harm to providers. A final report is expected in July. For a copy of Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors, Draft Technical Report for Review, visit the NQF website at