New payment procedures under the Affordable Care Act that will grant bonus payments to facilities that score higher on certain performance measures, such as patient satisfaction surveys, could have negative effects for safety-net hospitals, according to a study in the Archives of Internal Medicine, Reuters reports.
About the Study
Safety-net hospitals -- which typically serve low-income patients with government health insurance or who are uninsured -- tend to be rated lower on factors such as physician communication standards and pain management, according to researchers at Harvard University's School of Public Health.
The study is based on surveys conducted in 2007 and 2010 of patients at 3,096 hospitals. About one-quarter of the hospitals were safety-net hospitals.
Overall, 64% of patients who were treated at safety-net hospitals rated their experience as a 9 or 10 on a 10-point scale, compared with 70% of patients at other hospitals who gave the same ratings. Patients at safety-net hospitals also reported their experiences regarding communication about medications, discharge information, noise levels and nursing services as worse than the patients at the other hospitals.
Ashish Jha, one of the study's authors, said low-income and minority patients who often visit safety-net facilities are known to be distrustful of the health care industry. He added that many safety-net hospitals are dealing with budgetary problems, noting that they are "the one set of hospitals that will take care of anyone who comes through their door no matter what their ability to pay."
Reduced funding to the facilities under the new payment procedures could force some of the hospitals to close. "When safety-net hospitals shut down, it has huge effects on the entire marketplace," Jha said. He suggested that CMS provide safety-net hospitals with resources to improve patient care and then reward them for successfully making the changes.
In an editorial accompanying the study, the authors -- Katherine Neuhausen of UCLA and Mitchell Katz of the Los Angeles County Department of Health Services -- agreed that funding cuts are not the most effective strategy.
Neuhausen and Katz wrote, "[CMS] and state Medicaid agencies should design incentive programs that reward [safety-net hospitals] for improving patient experience and quality with the goal of closing the gap between SNHs and non-SNHs before implementing penalties" (Pittman, Reuters, 7/16).