Study examines patient experience at safety-net hospitals

July 16, 2012

A study suggests that safety-net hospitals (SNHs), which typically care for poor patients, performed more poorly than other hospitals on nearly every measure of patient experience and that could have financial consequences as hospital payments are connected to performance, according to a report published Online First by Archives of Internal Medicine.

Value-based purchasing (VBP), a program run by the Centers for Medicare and Medicaid Services (CMS), now ties part of each 's payments to its on a set of . Under the program, about 1 percent to 3 percent of total will be held back, and hospitals will receive some portion of that money based on how well they perform on VBP metrics. Part of each hospital's performance score will be determined using measures of patient-reported experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, according to the study background.

"For SNHs, ensuring high performance under VBP will be particularly critical to their ," according to the study background.

Paula Chatterjee, M.P.H., of the Harvard School of Public Health, Boston, and colleagues used the HCAHPS survey in 2007 and 2010 to determine performance and improvement on measures of patient-reported hospital experience among SNHs compared with non-SNHs. Their study included 3,096 U.S. hospitals, of which 769 were in the highest Disproportionate Share Hospital (DSH) index quartile and composed the SNH group.

Safety-net hospitals had lower performance than non-SNHs on nearly all measures of . The greatest differences were in overall hospital rating, for which patients in SNHs were less likely to rate the hospital a nine or 10 on a 10-point scale compared with patients in non-SNHs (63.9 percent vs. 69.5 percent). There also were sizable gaps for the proportion of patients who reported receiving discharge information (2.6 percentage point difference) and who thought they always communicated well with physicians (2.2 percentage point difference), according to the study results.

Safety-net hospitals were more likely than non-SNHs to be large hospitals that were for-profit or publicly owned, be major teaching hospitals and have fewer Medicare patients but more Medicaid and black patients than other hospitals, study results indicate.

Both groups of hospitals improved from 2007 through 2010, although the gap between SNHs and non-SNHs increased (3.8 percent in 2007 vs. 5.6 percent in 2010). SNHs also had 60 percent lower odds of meeting VBP performance benchmarks for hospital payments compared with non-SNHs, the results also indicate.

"Given that hospital payments are now tied to performance on these measures, we need renewed efforts to track performance of SNHs under VBP and may need specific quality-improvement programs targeting these organizations," the authors conclude. "Safety-net hospitals play a critical role in providing medical care to vulnerable populations, and ensuring that efforts to improve the quality of care at U.S. hospitals do not worsen existing disparities will be a key challenge to policy makers."

In an editorial, Katherine Neuhausen, M.D., of the University of California, Los Angeles, and Mitchell H. Katz, M.D., of the Los Angeles County Department of Health Services, California, write: "While it is important to improve quality at SNHs, the VBP program could push SNHs closer to the brink of bankruptcy."

"These hospitals will still be needed to care for the estimated 23 million individuals who will remain uninsured even if health care reform is fully implemented," they continue.

"The pursuit of value-based care is a worthy goal for SNHs. In its zeal to drive improvement, CMS [Centers for Medicare and Medicaid Services] should consider the precarious finances of the SNHs under health care reform. By continuing to support SNH incentive programs, CMS can provide vital resources for quality improvement and avoid a financial crisis among SNHs," the authors conclude.

Explore further: No improvement in patient outcomes seen in hospitals with pay-for-performance programs

More information:
Arch Intern Med. Published online July 16, 2012. doi:10.1001/archinternmed.2012.3158
Arch Intern Med. Published online July 16, 2012. doi:10.1001/archinternmed.2012.3175

Related Stories

No improvement in patient outcomes seen in hospitals with pay-for-performance programs

March 28, 2012
Paying hospitals to improve their quality of care, known as pay-for-performance, has gained wide acceptance in the U.S. and Medicare has spent tens of millions of dollars on bonuses and rewards for hospitals to improve. However, ...

Value of hospital environmental services linked to efficiency not expenses

July 18, 2011
The amount of money that hospitals spend on environmental services, such as cleaning and maintenance service is not as important in influencing patient satisfaction scores as the way the money is spent, according to Penn ...

Use of in-hospital mortality to assess ICU performance may bias quality measurement

May 21, 2012
In-hospital mortality for ICU patients is often used as a quality measure, but discharge practices may bias results in a way that disadvantages large academic hospitals, according to a recently conducted study.

Study: Worst hospitals treat larger share of poor

October 5, 2011
(AP) -- The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research ...

Recommended for you

Americans misinformed about smoking

August 22, 2017
After voluminous research studies, numerous lawsuits and millions of deaths linked to cigarettes, it might seem likely that Americans now properly understand the risks of smoking.

Women who sexually abuse children are just as harmful to their victims as male abusers

August 21, 2017
"That she might seduce a helpless child into sexplay is unthinkable, and even if she did so, what harm can be done without a penis?"

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

In a nutshell: Walnuts activate brain region involved in appetite control

August 17, 2017
Packed with nutrients linked to better health, walnuts are also thought to discourage overeating by promoting feelings of fullness. Now, in a new brain imaging study, researchers at Beth Israel Deaconess Medical Center (BIDMC) ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.