Voglio sapere a riguardo di…

42630

Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
lotter on DSK11XQN23PROD with RULES5

additional social risk factors, such as disability status, where accuracy of administrative data is currently limited.
We are mindful that additional resources, including data collection and staff training may be necessary to ensure that conditions are created whereby all patients are comfortable answering all demographic questions, and that individual preferences for non-response are maintained.
We are also interested in learning about and solicited comments on current data collection practices by facilities to capture demographic data elements such as race, ethnicity, sex, sexual orientation and gender identity SOGI, primary language, and disability status. Further, we are interested in potential challenges facing facility collection, at the time of admission, of a minimum set of demographic data elements in alignment with national data collection standards such as the standards finalized by the Affordable Care Act 63 and standards for interoperable exchange such as the U.S.
Core Data for Interoperability incorporated into certified health IT
products as part of the 2015 Edition of health IT certification criteria.64
Advancing data interoperability through collection of a minimum set of demographic data collection, and incorporation of this demographic information into quality measure specifications, has the potential for improving the robustness of the disparity method results, potentially permitting reporting using more accurate, self-reported information, such as race and ethnicity, and expanding reporting to additional dimensions of equity, including stratified reporting by disability status.
d. Potential Creation of a Facility Equity Score To Synthesize Results Across Multiple Social Risk Factors As we describe in section IV.D.3.a of this final rule, we are considering expanding the disparity methods to IPFs and to include two social risk factors dual eligibility and race/ethnicity.
This approach would improve the comprehensiveness of health equity information provided to facilities.
Aggregated results from multiple measures and multiple social risk factors, from the CMS Disparity Methods, in the format of a summary score, can improve the usefulness of the equity results. In working with our contractors, we recently developed an 63 https minorityhealth.hhs.gov/assets/pdf/

checked/1/Fact_Sheet_Section_4302.pdf.
64 https www.healthit.gov/sites/default/files/
2020-08/2015EdCures_Update_CCG_USCDI.pdf.

VerDate Sep<11>2014

21:11 Aug 03, 2021

Jkt 253001

equity summary score for Medicare Advantage contract/plans, the Health Equity Summary Score HESS, with application to stratified reporting using two social risk factors: Dual eligibility and race and as described in Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score.65
The HESS calculates standardized and combined performance scores blended across the two social risk factors. The HESS also combines results of the within-plan similar to the Within-Facility method and across-plan method similar to the Across-Facility method across multiple performance measures.
We are considering building a Facility Equity Score, not yet developed, which would be modeled off the HESS but adapted to the context of risk-adjusted facility outcome measures and potentially other IPF quality measures. We envision that the Facility Equity Score would synthesize results for a range of measures and using multiple social risk factors, using measures and social risk factors, which would be reported to facilities as part of the CMS Disparity Methods. We believe that creation of the Facility Equity Score has the potential to supplement the overall measure data already reported on the Care Compare or successor website, by providing easy to interpret information regarding disparities measured within individual facilities and across facilities nationally. A
summary score would decrease burden by minimizing the number of measure results provided and providing an overall indicator of equity.
The Facility Equity Score under consideration would potentially:
Summarize facility performance across multiple social determinants of health initially dual eligibility and indirectly estimated race and ethnicity;
and Summarize facility performance across the two disparity methods that is, the Within-Facility Disparity Method and the Across-Facility Disparity Method and potentially for multiple measures.
Prior to any future public reporting, if we determine that a Facility Equity Score can be feasibly and accurately calculated, we would provide results of the Facility Equity Score, in confidential facility specific reports, which facilities and their QINQIOs would be able to download. Any potential future 65 Agniel D, Martino SC, Burkhart Q, et al.
Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score. J Gen Intern Med.
Published online November 11, 2019 Nov 11. doi:
10.1007/s1160601905473x.

PO 00000

Frm 00024

Fmt 4701

Sfmt 4700

proposal to display the Facility Equity Score on the Care Compare or successor website would be made through future RFI or rulemaking.
c. Solicitation of Public Comment We solicited public comments on the possibility of stratifying IPFQR Program measures by dual eligibility and race and ethnicity. We also solicited public comments on mechanisms of incorporating co-occurring disability status into such stratification as well.
We sought public comments on the application of the within-facility or across-facility disparities methods IPFQR Program measures if we were to stratify IPFQR Program measures. We also solicited comment on the possibility of facility collection of standardized demographic information for the purposes of potential future quality reporting and measure stratification. In addition, we solicited public comments on the potential design of a facility equity score for calculating results across multiple social risk factors and measures, including race and disability. Any data pertaining to these areas that are recommended for collection for measure reporting for a CMS program and any potential public disclosure on Care Compare or successor website would be addressed through a separate and future noticeand-comment rulemaking. We plan to continue working with ASPE, facilities, the public, and other key stakeholders on this important issue to identify policy solutions that achieve the goals of attaining health equity for all patients and minimizing unintended consequences. We also noted our intention for additional RFIs or rulemaking on this topic in the future.
Specifically, we solicited public comment on the following:
Future Potential Stratification of Quality Measure Results The possible stratification of facility-specific reports for IPFQR
program measure data by dual-eligibility status given that over half of the patient population in IPFs are dually eligible, including, which measures would be most appropriate for stratification;
The potential future application of indirect estimation of race and ethnicity to permit stratification of measure data for reporting facility-level disparity results until more accurate forms of selfidentified demographic information are available;
Appropriate privacy safeguards with respect to data produced from the indirect estimation of race and ethnicity to ensure that such data are properly
E:FRFM04AUR5.SGM

04AUR5