Hospitals that mostly treat Medicaid patients have made smaller quality performance gains

May 14, 2008

Hospitals that predominantly treat poor and underserved patients (often referred to as safety-net hospitals) have made smaller improvements in quality performance measures in recent years compared to hospitals that do not primarily serve this patient population, according to a study in the May 14 issue of JAMA.

Safety-net hospitals often have lower quality of care than non–safety-net hospitals. While public reporting and pay for performance have the potential to improve quality of care at poorly performing hospitals, safety-net hospitals may be unable to invest in quality improvement. As such, some have expressed concern that these incentives have the potential to worsen existing disparities between hospitals, according to background information in the article.

Rachel M. Werner, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, and colleagues examined changes in differences in quality of care from 2004 to 2006 between safety-net and non–safety-net hospitals (high vs. low percentage of Medicaid patients) using publicly available data on hospital performance. Of the 4,464 participating hospitals, 3,665 (82 percent) were included in the final analysis.

The researchers found that hospitals with low percentages (5 percent) of Medicaid patients improved their performance significantly more than those with high percentages (40 percent) of Medicaid patients. “For example, hospitals with low percentages of Medicaid patients improved composite acute myocardial infarction [AMI; heart attack] performance by 3.8 percentage points, vs. 2.3 percentage points at those with high percentages of Medicaid patients. This resulted in a relative difference in performance gain of 39 percent. This pattern was repeated across most individual performance measures and all 3 condition-specific composite measures [AMI, heart failure and pneumonia],” the authors write.

Over time, hospitals with high percentages of Medicaid patients were less likely to be ranked as top performers, as reported on the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. “The percentage of hospitals in the top decile for AMI performance with high percentages of Medicaid patients decreased by more than half, from 10.1 percent in 2004 to 2.8 percent in 2006. At the same time, the percentage of hospitals in the top AMI performance decile with low percentages of Medicaid patients increased from 13.6 percent to 19.7 percent. These patterns held true across all 3 conditions.”

In a simulation model, hospitals with high percentages of Medicaid patients would have received smaller bonus payments and been more likely to incur penalties under pay for performance.

“Over time, trends such as these could damage the reputations of safety-net hospitals and worsen their financial status, potentially reducing their ability to further respond to quality-improvement incentives,” the researchers write.

“Improving quality of care at U.S. hospitals is a high priority, and improving quality of care for vulnerable populations is particularly important. Incentive programs such as public reporting and pay for performance may improve quality of care at many hospitals. However, these incentives may have unintended consequences, including exacerbating existing disparities in quality of care across hospitals. Our study suggests that safety-net hospitals may be unable to compete for performance bonuses. This has the potential to have deleterious effects on existing financial and clinical disparities in performance. As the CMS and others proceed with the implementation of incentives for quality improvement, it is imperative that steps be taken to ensure that disparities are not worsened.”

Source: JAMA and Archives Journals

Explore further: Informal child care significantly impacts rural economies, study finds

add to favorites email to friend print save as pdf

Related Stories

Health record app for Google Glass developed by Drchrono

Jun 15, 2014

The future of Google Glass in health care appears to be by now not a question of if but a question of where and when. Philips Healthcare, in its explorations into health care's future, created a video that ...

Compact proton therapy for fight against cancer

Jun 10, 2014

The future face of modern-day anti-cancer therapy based on charged particles like protons could potentially involve using laser accelerators. However, these facilities will need to be reduced in terms of ...

Smartwear revolution promises healthier lives

Jun 05, 2014

A new generation of wearable technology is promising not only to log data about users' health but to predict and avert crises—from drivers falling asleep at the wheel to runners wearing themselves out in ...

Nanotechnology takes on diabetes

Jun 02, 2014

(Phys.org) —A sensor which can be used to screen for diabetes in resource-poor settings has been developed by researchers and tested in diabetic patients, and will soon be field tested in sub-Saharan Africa.

Recommended for you

Preterm children's brains can catch up years later

11 hours ago

There's some good news for parents of preterm babies – latest research from the University of Adelaide shows that by the time they become teenagers, the brains of many preterm children can perform almost as well as those ...

Mortality rates increase due to extreme heat and cold

11 hours ago

Epidemiological studies have repeatedly shown that death rates rise in association with extremely hot weather. The heat wave in Western Europe in the summer of 2003, for example, resulted in about 22,000 extra deaths. A team ...

User comments : 0