M. Emerson1, S. Markowiak1,2, S. Pannell1,2, M. Nazzal1,2, F. C. Brunicardi1,2 1University Of Toledo Medical Center,College Of Medicine,Toledo, OH, USA 2University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
Introduction: The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), a standardized tool used in office settings to measure patient perceptions of care, was implemented for Physician Quality Reporting Systems (PQRS) beginning in 2012. By 2015, these publicly reported survey scores were tied to Medicare reimbursement for medical groups with over 100 eligible professionals. Understanding the impact of health disparities in social determinants of health is evolving. The purpose of our study was to determine whether CGCAHPS scores were influenced by social determinants of health (SDOH).
Methods: Data was drawn from the publicly reported Physician Compare datasets provided by the Centers for Medicare and Medicaid Services (CMS). We created a database linking medical practices with over 100 eligible medical professionals data to the corresponding census measures at the county level. Multivariate analysis and Pearson’s Correlation Coefficient (Pearson r) were used to test 133 SDOH against CGCAHPS score.
Results: All medical practices with over 100 medical professionals in 1,468 counties were analyzed. Of the 133 SDOH analyzed, 56 had statistically significant negative correlation with CGCAHS scores. 67 had a statistically significant positive correlation with CGCAHPS score. 10 measures were not statistically significant. Statstically higher CGCAHPS scores were associated with higher proportion of males (r=0.025, p<0.001), elderly patients (r=0.026, p<0.001), higher proportion of Caucasian patients (r=0.029, p<0.001), and greater proportion of persons employed in professional careers (r=0.024, p<0.001). Statstically lower CGCAHPS scores were associated with higher proportion of African American patients (r= -0.050, p<0.001), higher proportion of recent immigrants (r= -0.024, p<0.001), and communities with higher unemployment rates (r= -0.031, p<0.001).
Conclusion: Of the SDOH analyzed, 92.5% had a statistically significant correlation with CGCAHPS scores. 42.1% of SDOH analyzed showed negative correlations and 50.4% of SDOH showed positive correlations. CGCAHPS scores are directly tied to medical practices’ CMS reimbursement by federal law. Because of disparities in SDOH, the CGCAHPS survey will shift CMS reimbursement from medical practices in poor and diverse communities to medical practices in wealthier ones.