Risk Adjustment for Quality Measures Is Neither Binary nor Mandatory

Holding health care organizations and clinicians accountable for health care quality has been championed by the Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and health care payers for more than 15 years. More recently, quality assessment has increasingly emphasized outcome measures rather than process measures, as outcomes are of greater interest to patients and payers. However, because outcomes are less directly controlled by clinicians and health systems than processes, this emphasis has magnified the importance of using robust risk adjustment methods to control for factors beyond the reach of clinicians or health systems.