Noteworthy News

Safety-Net Hospitals Struggle With Medicare’s Value-Based Purchasing

health affairsSafety-net hospitals are more likely than others to fare poorly under Medicare’s value-based purchasing program.

Or so concludes a new study published in the journal Health Affairs.

Researchers examined the impact of the addition of patient mortality measures to the program in 2014, and according to the abstract of the new study,

We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program.

The study’s findings echo NAUH’s long-expressed belief that Medicare’s value-based purchasing program treats urban safety-net hospitals unfairly because of the especially challenging nature of the patients those hospitals serve.

In a 2013 letter, NAUH shared its concern over this problem with officials of the Centers for Medicare & Medicaid Services (CMS), writing that the program does not recognize the additional medical challenges posed by the kinds of patients urban safety-net hospitals serve and

… does not recognize the follow-up and after-care challenges these patients pose; and it does not recognize the stark reality that people living in poverty and with limited access to care are fundamentally harder to treat than the typical Medicare beneficiary. Without risk-adjusting for these factors, the value-based purchasing program is harming urban safety-net hospitals by penalizing them financially for factors often well beyond their control. Hospitals cannot pick and choose their patients, cannot focus solely on those who can easily be treated and sent on their way. The patients urban safety-net hospitals encounter are sicker than typical hospital patients and more complicated to treat, and these considerations should be taken into account in a better and more effective manner by Medicare’s value-based purchasing program.

See the new study “Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based Purchasing” here, on the Health Affairs web site.

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