When it comes to patient experience, U.S. safety-net hospitals – those serving a disproportionately larger number of low-income and Medicaid patients – are getting poor performance reviews, which may indicate they will struggle under value-based purchasing models.
According to a new study published by the Archives of Internal Medicine, U.S. safety-net hospitals scored lower than non-safety-net hospitals on nearly all measures of patient experience.
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For instance, researchers at the Harvard School of Public Health found that safety-net hospitals were 60 percent less likely to meet Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance benchmarks for hospital payments under the Medicare value-based purchasing program in HCAHPS' 2007 and 2010 surveys.
"Patient-reported experience with healthcare is an essential measure of how well a healthcare system functions. As such, improving patient experience in hospitals has become a major priority for both clinical leaders and policy makers. Prior studies in multiple healthcare settings have shown that poor self-reported experiences with the healthcare system are associated with slower recovery from illness and a lower likelihood of adherence to prescribed treatment regimens," said the study's authors in the report.
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The researchers compared HCAHPS performance and improvement for safety-net hospitals nationwide (defined as those in the highest quartile of the Disproportionate Share Hospital index) with other hospitals between 2007 and 2010, and found that the greatest differences were in overall hospital rating, where patients at safety-net hospitals were less likely to rate the hospital a nine or 10 on a 10-point scale compared with patients at other hospitals (63.9 percent compared to 69.5 percent).
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Although HCAHPS scores for both groups of hospitals improved, the study noted, the performance gap between them increased (from 3.7 percent in 2007 to 5.6 percent in 2010).
The study also found that gaps were sizeable for the proportion of patients who reported receiving discharge information (a 2.6 percentage point difference between safety-net hospitals and non-safety-net hospitals) and who thought they always communicated well with physicians (a 2.2 percentage point difference).
"There are two big reasons we wanted to study safety-net hospitals and their performance ratings. The first reason being that patients at these hospitals are particularly vulnerable," said Karen Joynt, one of the study's authors. "Prior studies show that people of minorities that are Medicaid patients report worst experiences at hospitals and they also have a lower trust in the medical system. Therefore, they're a group that needs extra trust in their hospitals for vulnerability reasons."
But the researchers also wanted to learn how well safety-net hospitals would do under value-based purchasing models. "… (V)alue-based purchasing means these hospitals get their payments back based on performances," Joynt said. "We would be particularly worried about these hospitals if their performance levels are lower."
Based on previous research done on safety-net hospitals, the researchers anticipated SNHs would do poorly on patient experience measures, but even with that expectation, they were surprised by their findings.
"I think that before the study started we were concerned they may do more poorly due to past surveys but I think we were surprised by the size of the differences between the two hospital groups," said Joynt. "This is a set of hospitals that sees a lot of challenges already so it's something we'll have to keep a close eye on as value-based purchasing rolls out. The intention of value-based purchasing is to improve outcomes, not single out hospitals."