According to a nationwide study published online in Archives of Internal Medicine, patients at safety-net hospitals (SNHs), which usually care for poor patients, are significantly less satisfied with their hospital experience than patients at other hospitals.
The Centers for Medicare and Medicaid Services (CMS) currently runs a value-based purchasing (VBP) program that holds 1-3% of each hospital's total Medicare payments. A portion of that money is then reimbursed to the hospitals, depending on how well they perform on a set of quality measures.
Measures of patient-reported experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey will be used to help determine each hospital's performance score.
The researchers explained:
"For SNHs, ensuring high performance under VBP will be particularly critical to their economic viability."
Paula Chatterjee, M.P.H., of the Harvard School of Public Health, Boston, and team analyzed data from the HCAHPS survey of 3,096 U.S. hospitals in 2007 and 2010. These included 769 safety-net hospitals.
The team found that SNHs performed worse than non-SNHs on nearly all measures of patient experience. In addition, patients in SNHs were less likely to rate the hospital a 9 or 10 on a 10-point scale than patients in non-SNHs (63.9% vs, 69.5%, respectively).
Results also showed that there was a 2.6% point difference in the number of patients who reported receiving discharge information and a 2.2% point difference in patients who believed they always communicated well with their physicians.
According to the researchers SNH were more likely:
- To be large hospitals
- To be for-profit or publicly owned
- To be major teaching hospitals
- To have less Medicare patients
- To have more Medicaid patients
- To have more black patients
In addition, SNHs were 60% less likely to achieve VBP performance benchmarks for hospital reimbursements than non-SNHs.
The researchers conclude:
"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.
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."
Written by Grace Rattue