Study Questions Impact of Pay for Performance on Safety Net Hospitals
Safety net hospitals that cater to low-income and uninsured patients likely will not benefit from pay-for-performance programs in the same way that other hospitals do, according to a study published in the Journal of the American Medical Association, Bloomberg News reports (Goldstein, Bloomberg News, 5/13).
The study examined changes in quality between 3,665 safety net and non-safety net hospitals between 2004 and 2006 (Reinberg, HealthDay/U.S. News & World Report, 5/13).
Researchers from the Veterans Affairs Department in Philadelphia used data from a Medicare pay-for-performance pilot program to run a simulation of payments for all U.S. hospitals. In the pilot, hospitals ranked in the top 10% get 2% Medicare payment bonuses, while hospitals in the lowest 10% are penalized.
Researchers said the disparities are widened by pay-for-performance policies from insurers that reward hospitals for meeting certain benchmarks of quality care.
The study found that payments to hospitals with the fewest low-income patients increased by 32% from 2004 to 2006, while quality bonuses for hospitals treating the greatest percentages of low-income patients declined by 66%.
Raising pay-for-performance scores costs money that hospitals serving the poor and racial minorities do not have, according to Rachel Werner, lead author of the study.
"We should not back away from pay-for-performance measures that have been adopted, but they may need to be applied differently to safety net hospitals," Werner said. She added that the system is "just penalizing the patients who get care at those hospitals" (Bloomberg News, 5/13).