In an analysis published Sept. 6 in JAMA Network Open, researchers examined five definitions for safety-net hospitals and found that different criteria captured varying hospitals and characteristics. As a result, when CMS uses one definition to allocate funding, some hospitals are excluded and may not receive the necessary funding to continue to provide care.
Five things to know:
1. Researchers from the NYU School of Global Public Health in New York City detailed various definitions for safety-net hospitals by taking into account factors including uncompensated care costs, hospital ownership and patients covered by Medicaid.
2. CMS has developed one such definition — disproportionate share hospital payments — to allocate funding to safety-net hospitals. DSH payments are calculated based on the share of care provided to patients receiving Social Security payments and Medicare and Medicaid coverage.
3. Researchers examined the characteristics of 5,955 hospitals in the U.S and applied five different definitions of safety-net hospitals: those with the most DSH payments, Medicaid inpatient days, Medicaid inpatient days or public hospitals, public hospitals or teaching hospitals, and public hospitals. They also considered different characteristics of the hospitals, such as whether they were rural, for profit or nonprofit, the number of beds they have, whether they were in a Medicaid expansion state, and the clinical complexity of their patients.
4. Each safety-net definition had a significantly different set of hospitals with varying characteristics, according to the study. For example, defining safety-net hospitals using only DSH payments accounted for 11.4 percent of U.S. hospitals and included the fewest rural and public facilities, but defining safety-net hospitals as public or teaching facilities included 55.2 percent of hospitals.
5. Researchers advocated for the adoption of a universal definition for a safety-net hospital index to create more precision around identifying hospitals for funding and highlighted the risk of allocating funding based on Medicaid care because of uneven Medicaid coverage across the country.
Click here for more details on the study.
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