A recent study, Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients, published in Health Affairs reported some previously unknown statistics that could have serious implications for Medicare‘s Value-Based Purchasing Program. In the Commonwealth Fund supported study, the Harvard researchers led by Ashish K. Jha found that low-performing hospitals with high costs have double the proportion of elderly black patients compared to high-quality, low-cost hospitals. Similar disparities were also found for elderly Hispanic and Medicaid patients.
The researchers report that the lower-performing hospitals are the typical small public or for-profit institutions in the South, while the higher-performing facilities are mostly nonprofit institutions in the Northeast. According to the authors of the study “The fact that the worst hospitals have more than twice the proportion of elderly black patients than the best hospitals is both startling and unknown.”
Hospital data was drawn from different sources including Hospital Compare, Medicare, the American Hospital Association, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Process measures were used to assign quality of care scores for acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications.
Because the Affordable Care Act authorizes Medicare to give out higher payments to hospitals that achieve better performance while cutting reimbursements for those hospitals that fail to perform better, hospitals that can simultaneously provide high-quality care and manage their costs well are likely to come out ahead under health reform, the authors say. Financial penalties incurred by lower-performing hospitals may inadvertently worsen existing disparities in health care unless these hospitals improve on quality and cost of care.