As part of the Department of Health and Human Services (HHS) ongoing efforts to improve equity across programs, the CMS released new confidential reports for post-acute care providers including skilled nursing facilities and home health agencies to identify individuals in their patient populations which are at risk for increased poor health outcomes due to social risk factors (SRFs) including low-income status or being from a certain race/ethnicity. The Stratified Health Equity Confidential Feedback Reports will provide data to individual home health agencies and skilled nursing facilities on whether difference in measure outcomes is present for individuals with SRFs in their agency/facility. These reports can be used by providers to develop strategies using their internal quality improvement initiatives to reduce the impact of SRFs for their patients.

To develop these reports, CMS used data from Medicare Part A and B claims, Medicare enrollment data, and the Medicare Bayesian Improved Surname Geocoding method (used to estimate beneficiaries’ race and ethnicity). Two reports will be available based on the following cross-setting, post-acute measures:

Discharge to Community (DTC): captures the successful discharge to the community from the given post-acute setting meaning no unplanned rehospitalizations or deaths in the 31 days post-discharge.

Medicare Spending Per Beneficiary (MSPB): captures the efficiency of care per post-acute care treatment period and for 30 days after including the costs of emergency room or hospital admissions.

To provide insight on outcome differences across SRFs for these PAC Quality Reporting Program measure outcomes, the Health Equity Confidential Feedback Reports stratify these by Medicare-Medicaid dual-enrollment status (duals and non-duals), as well as patient race/ethnicity (Non-White and White patients). The non-white patient SRF included stratification by Asian American, Native Hawaiian and Pacific Islander, Black and Hispanic.

The individual agency and facility reports will include “Across-Provider Comparisons”, which will compare your agency to all other providers in the same care setting (e.g. SNF or HHA), and “Within-Provider Comparisons” which will compare stratified patient populations within your individual provider’s care (e.g. dual patients compared to non-duals.) The chart below details each of the comparisons.

The reports will also include comparisons to agencies or facilities with similar geographical locations or similar patient composition.

The Fall 2023 PAC Health Equity Confidential Feedback Reports are confidential, and not publicaly reported. These reports will be updated annually moving forward. For home health agencies the performance period reported on will be Calendar Year 2021-2022. For Skilled Nursing Facilities the performance period will be Fiscal Year 2021-2022. CMS will be exploring the potential of expanding this confidential feedback report to other measures and other SRFs and/or demographic variables for future reporting. CMS is also exploring the use of different post-acute care assessments data as a source for SRF and demographic variables.

To access your agency or facility reports follow these steps:

1. Log into iQIES using your Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) user ID and password. If you do not have a HARP account, you may register for a HARP ID.
2. From the Reports menu, select My Reports.
3. From the My Reports page, locate and select the Health Equity Confidential Feedback Reports folder link.
4. Displayed for you is a list of reports available for download.
5. Select the report name link to view the Health Equity Confidential Feedback Report data

Additional Resources

• Online Webinar recording
• Fact Sheet
• Webinar Transcript and Webinar Slides
• Diversity, Equity & Inclusion LeadingAge Learning Hub Materials