Safety-net hospital patients have worse outcomes: Study suggests 'intrinsic qualities' are to blame

A new study suggests the "intrinsic qualities" of safety-net hospitals lead to surgical care that is inferior and more expensive.

Safety-net hospitals have higher mortality and readmission rates, as well as higher costs associated with surgical care. These outcomes remained even after adjusting data for patient characteristics and hospital procedure volume, according to the study in JAMA Surgery.

"These outcomes are likely owing to hospital resources and not necessarily patient factors. In addition, impending changes to reimbursement may have a negative effect on the surgical care at these centers," the study concludes.

Researchers examined 231 hospitals and more than 12.6 million patient encounters using data from the University HealthSystem Consortium and CMS' Hospital Compare data. They found safety-net hospitals had lower performance on Surgical Care Improvement Project measures, higher rates of surgical complications and poorer performance on emergency department timeliness measures, possibly as a result of inefficient systems and staffing.

In an interview with JAMA Surgery, Shimul Shah, MD, one of the study's authors, said competitive forces will increasingly necessitate that hospitals and providers become "focus factories" or specialize in certain services and close other programs in an effort to be more cost effective.

When it comes to this, safety-nets are at a disadvantage. "Safety-net hospitals, though, must care for all patients and are unable to streamline these services to maximize profits so as a result these providers have a limited ability to compete in the…market and are less able to adapt in times of financial stress without adversely affecting their patients."

Lack of resources at safety-net hospitals may prevent them from pursuing quality improvement initiatives, he said, and "financial penalties for these providers may further…not induce the desired effect of improving outcomes…but may actually do the opposite in safety-net hospitals."

He suggested that reimbursement policies should consider hospital factors in addition to patient outcomes. "I think that appropriate risk-adjustment reimbursement policies really need to include the hospital as well as the patient," he said. "Right now, it looks like they're primarily only including the patient and the patient risk factors."

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