Blog | Wednesday, July 18, 2012

QD: News Every Day--Safety-net hospitals could face pay hurdles under health care reform


Health care reforms may prevent safety-net hospitals from fully recouping Medicare dollars, a study cautioned.

Provisions of the Affordable Care Act tie from 1% to 3% of hospital payments to quality measures, one of which is patient-reported experience from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

This is a safety-net hospital's Achilles' heel, the authors report, since these facilities had lower performance than non-safety-net hospitals on all patient experience measures except quietness of hospital environment.

Results appeared online at Archives of Internal Medicine.

Researchers looked at nearly 3,100 hospitals that scored in the highest quartile of the Disproportionate Share Hospital index and how they fared in the Hospital Consumer Assessment of Healthcare Providers and Systems survey in 2007 and 2010.

Safety-net hospitals were more likely to be:
--large hospitals that were for profit or publicly owned,
--major teaching hospitals,
--in the South and West,
--staffed with fewer nurses,
--serving fewer Medicare patients and more Medicaid and black patients.

The greatest differences were in overall hospital rating, where patients in safety-net hospitals were less likely to rate the hospital a 9 or 10 on a 10-point scale compared with patients in non-safety-net hospitals (63.9% vs. 69.5%; P less than .001).

Other differences were reported for the proportion of patients receiving discharge instructions (2.6 percentage point difference; P less than .001) and who thought they always communicated well with physicians (2.2 percentage point difference; P less than .001).

Although both groups of hospitals improved from 2007 through 2010, the gap in overall rating between safety-net hospitals and non-safety-net hospitals increased (3.8% in 2007 vs. 5.6% in 2010; P=.08).

Researched reported that safety-net hospitals had a 60% lower odds of meeting performance benchmarks for hospital payments (odds ratio, 0.4; 95% confidence interval, 0.3 to 0.5; P less than .001) compared with non-safety-net hospitals.

"Although the new VBP [value-based purchasing] rules pay for improvements as well as achievement, our findings suggest that SNHs [safety-net hospitals] face challenges on both fronts," the authors concluded. "If SNHs are unable to substantially improve patients' experiences over the next several years, hospital-based incentive programs are likely to disproportionately penalize these institutions."