Patients Report Poor Experiences at Safety-Net Hospitals

View on the News

Safety-Net Hospitals Serve Us All

It would be "a tragedy" if pay-for-performance rules "push[ed] safety-net hospitals closer to the brink of bankruptcy," said Dr. Katherine Neuhausen and Dr. Mitchell H. Katz.

Even after the Affordable Care Act goes into effect, safety-net hospitals will be crucial to the care of an estimated 23 million patients who will still be uninsured. Closure of safety-net hospitals would devastate medical education, "and would also be detrimental to the millions of insured Americans who rely on them for specialized services such as trauma care, disaster relief, burn treatment, neonatal intensive care, psychiatric care, and substance abuse treatment," they noted.

Katherine Neuhausen, M.D., is at the University of California, Los Angeles. Mitchell H. Katz, M.D., is at the Los Angeles County Department of Health Services. They reported no financial conflicts of interest. These remarks were taken from their editorial comment accompanying Ms. Chatterjee’s report (Arch. Intern. Med. 2012 July 17 [doi:10.1001/archinternmed.2012.3175]).



Patients at safety-net hospitals rated their hospital experience as markedly poorer on 9 of 10 measures than did those at other hospitals in a nationwide study published online July 17 in Archives of Internal Medicine.

These gaps in performance between safety-net and other hospitals "were sizeable and persistent over time," said Paula Chatterjee, of the department of health policy and management, Harvard School of Public Health, and a medical student at Harvard Medical School, both in Boston, and her associates.

Copyright Aubrey LaMedica

Paula Chatterjee, MPH

Safety-net hospitals play a critical role in providing medical care to vulnerable, typically poor populations, and they are essential to medical education. Given that hospital reimbursement is now tied to performance, these study findings may portend the financial ruin of these institutions, the researchers said.

Their results "should renew our focus on helping these hospitals improve," they added.

Ms. Chatterjee and her colleagues analyzed data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys of 3,096 acute-care U.S. hospitals in 2007 and 2010. These included 769 safety-net hospitals.

The surveys queried patients who had recently been hospitalized about their experience on eight specific measures:

• Communication with physicians.

• Communication with nurses.

• Communication about medications.

• Quality of nursing services.

• Presence of discharge planning.

• Pain management.

• Cleanliness.

• Quietness of the hospital environment.

Patients also responded to two global measures of their experience: an overall rating on a scale from 1 to 10, and whether they would recommend the hospital to family and friends.

Safety-net hospitals scored considerably lower than did other hospitals on all of these measures except quietness of the hospital environment, the investigators said (Arch. Intern. Med. 2012 July 17 [doi: 10.1001/archinternmed.2012.3158]).

In 2010, 26% of the best-performing hospitals scored at or above the median on the eight specific measures of patient experience, while only 11% of safety-net hospitals did so. The median is an important cutoff for hospital reimbursement under Medicare’s Value-Based Purchasing Program.

Safety-net hospitals had a 60% lower odds of achieving this key pay-for-performance benchmark than did other hospitals – a "striking disparity" indicating that these already financially strapped facilities stand to lose even more money, the researchers noted.

All hospitals showed some improvement in the measures of patient experience between 2007 and 2010, but safety-net hospitals showed the smallest improvement.

However, it is possible that hospitals’ efforts to improve their performance in this area may take longer to produce results. "Tracking how this group of hospitals fares over time will be critically important," Ms. Chatterjee and her associates said.

The researchers reported having no financial conflicts of interest.

Recommended Reading

Justices Uphold ACA, Strike Medicaid Expansion
MDedge Cardiology
Public Reacts to Supreme Court ACA Ruling
MDedge Cardiology
Head for the Hill: ACA Pushes More Doctors onto the Ballot
MDedge Cardiology
What's Next for the ACA?: The Policy & Practice Podcast
MDedge Cardiology
GSK Pays $3 Billion to Settle Drug Promotion Charges
MDedge Cardiology
Post-MI Rehospitalization Rate Has Not Declined Since 1987
MDedge Cardiology
Supreme Court Ruling Just the Beginning for Health Reform
MDedge Cardiology
Tracking System Proposed for Medical Devices
MDedge Cardiology
Medicare Seeks to Pay for Postdischarge Coordination
MDedge Cardiology
Physicians Grapple With Efficiency, ‘Do No Harm’
MDedge Cardiology