More than a decade has passed since the landmark Institute of Medicine report Unequal Treatment documented the sizeable and pervasive disparities that affect the US health care system.1 Yet there has been little evidence of progress toward eliminating, or even reducing, these inequities in care. Furthermore, there is increasing concern that existing policy efforts designed to improve quality may, in fact, worsen disparities in care. Most recently, the Medicare pay-for-performance effort with the largest financial penalties, the Hospital Readmissions Reduction Program, was found to disproportionately penalize safety-net facilities that primarily care for disadvantaged and poor populations.2 Findings such as these have prompted national discussions about the possibility of adjusting quality-performance scores for the socioeconomic status (SES) of patient populations.3
Jha AK, Zaslavsky AM. Quality Reporting That Addresses Disparities in Health Care. JAMA. 2014;312(3):225–226. doi:10.1001/jama.2014.7204
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