Under CMS’s value-based reimbursement models, physicians (and health systems) receive more pay for realizing quality patient outcomes.

But what about when the patients themselves prevent quality outcomes?

It’s long been known, but unaddressed, that negative social determinants of health (SDOH) — poverty, lower education levels, substance abuse, etc. — are not only primary factors that generate disease, but primary factors, too, in treatment failure.

That puts doctors who treat patient populations in economically challenged or under-resourced communities at a serious pay disadvantage under VBC models.

In an op-ed for The New York Times, the Weill Cornell Department of Healthcare Policy and Research’s Dr. Dhruv Khullar suggested that SDOH should be accounted for in CMS’s reimbursement programs.

Particularly, he noted that, by their very nature, Medicare’s VBC penalties could simultaneously exacerbate the problem among highly-challenged patient populations.

“Patients with more social risk factors have worse outcomes regardless of who they see,” Khullar wrote. “Doctors who care for disadvantaged populations need more resources to produce comparable health outcomes, but they’re less likely to have them.”

Read Khullar’s full op-ed here, in The New York Times.