I have shown, in my previous work, that social risk factors affect hospital performance. CMS, at th eurging of Congress, will be including including social risk factors in their patient risk models. Here is an interesting paper that examined retrospectively the effect of adjustment for social risk factors on readmission penalties and found that the penalties will drop by almost half for safety-net hospitals. I am certain that these adjustment will bring more fairness in hospital comparisons and will decrease the amount of penalty these safety-net hospitals have to face.
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