A recent Yale study of the care quality received at safety-net hospitals in metropolitan areas of the U.S., which provide care for the majority of uninsured, low-income and other vulnerable populations, found that the quality at these facilities is nearly the same compared to non-safety-net hospitals in the same areas.
Even though safety-net hospitals have historically faced greater financial strains, especially with rising costs and the potential impact of the new healthcare law, their performances related to outcomes for acute myocardial infarction, heart failure and pneumonia were effectively identical to non-safety-net hospitals in the same urban metro areas, according to the study, which was published in the August issue of Health Affairs.
Safety-net hospitals include both public and private urban hospitals with high Medicaid case loads serving large numbers of low-income, uninsured and vulnerable populations. The financial strains historically attached to safety-net hospitals were thought to negatively affect patient death rates and readmissions, which are commonly used as indicators of care quality.
“We see a really wide range of performances across safety-net hospitals and they look very similar as non-safety-nets. There are concerns that safety nets don’t do as well with readmissions but when we look at the each of the measures we studied, they aren’t that different,” said Elizabeth Drye, an author of the study and director of quality measurement programs at the Yale Center for Outcomes Research and Evaluation. “Differences for five of the six measures were small ones. A lot of safety-net hospitals are doing really well, bottom line.”
Drye and her fellow authors studied a population that included fee-for-service Medicare patients ages 65 or older who were hospitalized between Jan. 1, 2006 and Dec. 31, 2008 with acute myocardial infarction, heart failure or pneumonia. They then compared death and readmission rates at both kinds of hospitals in metropolitan areas.
“We were surprised to find that mortality and readmission rates were broadly similar across urban areas for both safety-net and non-safety-net hospitals, with differences, on average, of less than one percentage point across these three conditions. For heart failure mortality, there was no difference between the two kinds of hospitals,” said Joseph S. Ross, one of the study’s authors and an assistant professor of internal medicine at Yale School of Medicine, in a written statement.
Drye mentioned that as insurance coverage expands with the Affordable Care Act (ACA), safety-net hospitals might be able to achieve even lower readmission and mortality rates.
“In general, these hospitals are doing well, and we want to keep tracking how they are doing especially as we under go changes with the ACA,” she said.