Federal payment changes may harm hospitals serving poor

Hospitals that treat mostly poor and uninsured patients generally perform slightly worse than others when patients rate their hospital experiences, according to a study led by Harvard School of Public Health researchers. The lower patient ratings could negatively impact these so-called safety-net hospitals (SNHs) under reimbursement changes to occur under the Affordable Care Act. Under the act, a portion of Medicare and Medicaid funding to hospitals will be determined by performance measures, including patient ratings.

Senior author Ashish Jha, C. Boyden Gray Associate Professor at HSPH, and lead author Paula Chatterjee, a student at Harvard Medical School, and colleagues used the Hospital Consumer Assessment of Healthcare Providers and Systems 2007 and 2010 survey to determine performance and improvement on measures of patient-reported hospital experience among SNHs compared with non-SNHs. The study included 3,096 U.S. hospitals; 769 were in the SNH group. Safety-net hospitals were more likely to be large hospitals that were for-profit or publicly owned, be major teaching hospitals, and have fewer Medicare patients but more Medicaid patients. The authors found patients treated at SNHs consistently rated their in-hospital experiences lower than patients at other hospitals.

The study was published July 16, 2012 online in Archives of Internal Medicine. Other HSPH faculty who participated include Karen Joynt, instructor in health policy and management, and E. John Orav, associate professor of biostatistics.

While accountability for quality care is good, steps should be taken to make sure the important care provided by these hospitals doesn’t push SNHs into bankruptcy, Jha told the Chicago Tribune on July 16. SNHs often are financially stressed as they treat many patients who are uninsured or have government insurance that pay hospitals less than private insurance. “They’re the one set of hospitals that will take care of anyone who comes through their door no matter what their ability to pay,” Jha said. “When safety-net hospitals shut down, it has huge effects on the entire marketplace.”

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Archives of Internal Medicine press release

Department of Health Policy and Management