Mulligans, handicaps and Medicare.

Not sure what you’re seeing when looking towards the future of the RO-APM? Let’s turn to the past. Since 2012, CMS has been reforming its payment structure for hospitals, and that often includes penalizing for readmissions straight up House of God style. Soon came the outcries that this model doesn’t account for varying patient populations, putting the hurt on safety-net hospitals taking care of some serious gomers. Congress took a mulligan and passed the 21st Century Cures Act requiring Medicare to give handicaps based on “social risk.” In the short term that meant a simple tally of patient income, but the statute allows for different ways to measure social risk to be implemented in the future. This retrospective look at Medicare claims data indicates a more nuanced, if still common sense, approach should also include disability, housing instability, and living on the wrong side of the tracks. Adding these social factors to risk adjustment majorly evened-out the playing field, resulting in over half of analyzed safety-net hospitals looking at reduced (albeit not absent) penalties. TBL: An equitable model for bundled payments ain’t simple. | Joynt-Maddox, Health Serv Res 2019