Risk Stratification in Patient Outcomes

Risk Stratification in Outcomes

Risk Stratification. It is a thing. Perhaps it is THE Thing. CODE Technology agrees and applauds requests for help from the Center for Medicare and Medicaid Services (CMS) on how to incorporate risk stratification into performance measures, as well as the American Academy of Orthopaedic Surgeons (AAOS) stance and response to CMS related to the subject.

Patient-Reported Outcomes Measures are playing a big role in value-based reimbursement

Measurement, analysis, and comparison of Patient Reported Outcome Measures (PROMs) is an important tool for physicians, payers, and patients. PROMs provide valuable information on patient procedures and quality of care. Value-based reimbursement continues to grow as the compensation of choice, PROMs are one of the metrics being chosen by CMS for the determination of quality and value. In the May 10, 2021, Federal Registry, CMS requested information from stakeholders on PROMs and how to electronically collect and report. AAOS replied to CMS, and while AAOS supported PROMs as a tool, AAOS also cautioned that PROMs alone are just one metric and require further risk stratification to occur.

There is no “one size fits all” for patient care

Patients are not all the same and there is clear evidence that certain patient-related health factors influence outcomes and the perception of quality if compared directly with other “healthier” patients. As physicians and the AAOS pointed out, patients have different risk factors that influence their outcomes. While PROMs are an extremely useful metric to compare, analyze, and evaluate quality, they cannot be used in a vacuum without consideration of various other risk factors.

There are many ways to stratify risk, and there is an ongoing effort to understand which factors are most important

It is understood that an individual’s personal health factors influence how they will respond to medical intervention. Risk factors such as:

• Body Mass Index (BMI)
• Smoking and Tobacco Use
• Diabetes
• Age

These factors, among others, influence a patient’s outcome and compliance, and can also determine the setting of that care, such as an in-patient hospital, out-patient hospital, ambulatory surgical center, or in a provider’s office. 

Risk stratification must also be considered when evaluating outcomes and comparing PROMs to other providers or organizations. Providing a risk stratification value to patients or aggregate to a provider or organization can balance out a provider’s or organization’s potential risk inherent in performing procedures on the population they serve, making the PROMs more valuable and comparable between the patient population of various providers and organizations.

Having the ability to risk-stratify your data enables better decision-making and interpretation of insights

CODE helps to analyze these risk factors and provides guidance and support in collecting PROMs. Stay tuned for our BMI Risk strat report in total joints that will be coming to a blog near you soon!