Written by Stacy Johnson, Clinical Consulting Manager, McBee

The Centers for Medicare & Medicaid Services (CMS) has released the Health Equity Report as part of its ongoing commitment to improve health outcomes. The goal of the report is to present valuable insights into how different patient populations are performing on specific health measures, helping to identify and address disparities.

Defining Health Equity

CMS defines health equity as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language or other factors that affect access to care and health outcomes.

Purpose of the Health Equity Reports

The Health Equity Reports focus on two key measures: discharge to community and Medicare spending per beneficiary. These measures are stratified by two main factors: beneficiaries’ dual enrollment status (whether they are enrolled in both Medicare and Medicaid) and race or ethnicity. The goal is to compare measure outcomes between fee-for-service Medicare, Medicaid dually enrolled patients (duals), and non-duals, as well as between non-white and white patients.

Stratification Explained

Stratification involves calculating certain outcomes separately for different populations. This approach allows providers to see how the outcomes of their care may differ for certain patient populations, which would not be apparent from an overall score averaged over all beneficiaries. By stratifying data by dual enrollment status and race or ethnicity, the reports can reveal insights into how social risk factors may impact health outcomes.

Why Dual Enrollment Status and Race/Ethnicity?

CMS has chosen dual enrollment status and race/ethnicity as stratifiers because these factors are often associated with increased risks of poor health outcomes. Social risk factors like low-income backgrounds and specific racial or ethnic identities can influence access to care and health outcomes. By focusing on these stratifiers, CMS aims to highlight disparities that need to be addressed to achieve health equity.

Report Methodology

The Health Equity Reports provide three types of comparisons:

  1. National Performance Comparison: Compare your facility’s performance to the national performance for all patients. For example, compare your Inpatient Rehabilitation Facility’s (IRF) dual discharge to community rate versus the national discharge to community rate across all IRF patients.
  2. Population-Specific National Comparison: Compare your facility’s performance to the national performance among the same population. For example, compare your IRF’s dual discharge to community rate versus the national discharge to community rate among all duals in IRFs nationwide.
  3. Internal Population Comparison: Compare measure outcomes between different patient populations within the same IRF. For example, compare your IRF dual discharge to community rate versus your IRF nondual discharge to community rate.

For each comparison, the report will categorize your facility’s performance as statistically significantly better than, no different from or worse than the comparison group.

Utilizing the Reports

These reports are intended to help providers identify opportunities for quality improvement. By understanding how different patient populations are performing on key measures, providers can focus their internal quality improvement initiatives to ensure that all individuals have the best opportunity to achieve optimal health outcomes.

To receive a Health Equity Report, providers need to have an iQIES account and meet the reportability requirements, which include having a comparison result for at least one race or ethnicity or dual status population.

The CMS Health Equity Reports are a crucial tool in the effort to achieve health equity. By providing detailed insights into the performance of different patient populations, these reports help healthcare providers identify and address disparities, ensuring that everyone has a fair and just opportunity to attain the highest level of health. Through these efforts, CMS continues to lead the charge towards a more equitable healthcare system for all.

IRF-PAI Quarterly Q&As

CMS also provides quarterly updates in a question-and-answer format. These are a great source of information and it’s important to note that the information posted in these quarterly Q&As supersedes what’s been posted in the most recent IRF-PAI manual updates.

It’s important to continue to submit questions to CMS, providing real-life questions so they are considered and potentially published for updated direction. Several questions that were in previous quarterly Q&As have been archived. Even if it looks like nothing new has been added, check for what may have been archived or edited. One way to keep updated on changes is to sign up for Medicare emails to receive notifications when these come out.

You can access the manual and Q&As here. The manual and change table are available in the ‘Downloads’ section of this webpage.

Click here to listen to our recent IRF Industry Insights webisode on Health Equity Reports

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