Quality-Based Payments Could Hurt Low-Income, Minority Patient Groups
Medicare policies that pay hospitals based on quality could exacerbate health care disparities because lower-performing hospitals often treat a higher number of low-income and minority patients, according to study in Health Affairs, National Journal reports (Sanger-Katz, National Journal, 10/5).
For the study, Harvard School of Public Health researchers and colleagues examined quality of care, costs and patient population at about 3,200 hospitals nationwide. They identified the 122 "best" hospitals and 178 "worst" hospitals, based on ratings for quality and costs (Johnson, AP/Google News, 10/5).
The worst hospitals typically were smaller than the best hospitals, were usually public or for-profit facilities and tended to be in the South. Meanwhile, the best hospitals generally were not-for-profit institutions located in the Northeast. Best hospitals often offered cardiac ICUs and treated a higher average proportion of Medicare patients than the nation's worst hospitals.
The researchers found that elderly black patients accounted for almost 15% of patients at the nation's worst hospitals, but fewer than 7% of patients at the best hospitals. Meanwhile, Medicaid enrollees accounted for 23% of patients at the worst hospitals versus about 15% at the best hospitals. The results also revealed that myocardial infarction or pneumonia patients were more likely to die if admitted to a low-quality hospital (National Journal, 10/5).
Value-Based Purchasing Might Deepen Divide
The study notes that the care disparity between the "best" and "worst" hospitals likely will grow when Medicare payment models in 2013 begin to cut reimbursement to facilities that fail to meet quality benchmarks.
Lead researcher Ashish Jha said, "While value-based purchasing is well-intended, many hospitals that disproportionately care for minorities and the poor will fare poorly because they will have to improve quality to avoid financial penalties" (AP/Google News, 10/5).
High-Cost, High-Quality Hospitals Had Higher Satisfaction Scores
The researchers also examined high-quality, high-cost hospitals, which tended to be large, urban teaching hospitals that have higher nurse-to-patient ratios. They found that such hospitals earned significantly higher patient satisfaction scores than other institutions.
According to Jha, the higher scores could be attributed to having more nurses on staff. He notes that high-cost, high-quality hospitals might be spending more to provide services that patients value, such as greater access to staff. "In the move toward greater efficiency, we want to make sure hospitals don't cut things that optimize patient hospital experiences," he said (National Journal, 10/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.