Do hospitals that treat more low-income, ethnically diverse patients with multiple comorbidities have a tougher time getting good patient experience scores than other hospitals, as some organizations contend?
And if so, should those hospitals merit an adjustment for socioeconomic status or payer mix, especially when millions in value-based purchasing incentive pay is now at stake?
Safety-net advocacy groups say the Hospital Consumer Assessment of Healthcare Providers and Systems surveys should be adjusted for race, ethnicity, income, and health literacy as well as insurance status because HCAHPS misses a measure of hospital cultural competence.
But to date, the Centers for Medicare & Medicaid Services has disagreed, arguing that existing adjustments—such as for age, education, and the patient's primary language—are adequate.
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