10 October 2011


Story first appeared in the Associated Press.

The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows.
Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That's because the nation's new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs.
These hospitals are going to have a much harder time in the new funding environment. It is worried that they're going to get worse over time and possibly even fail, and that this will happen to several over the next three to five years.
Under the Affordable Care Act, hospitals that fail to improve will see their Medicare payments shrink by 1 percent starting October 2012. That could jeopardize some hospitals already on the brink of closure.
That unintended consequence of the health overhaul could increase health disparities for minorities.
The study shows that we have to make sure we pay attention to what the results of those policies are and be ready to change directions if they're causing harm in the marketplace.
The study doesn't name the 178 hospitals the researchers rated as "worst" because of their low quality of care and high costs. A data use agreement with Medicare prevented the researchers from identifying the hospitals publicly.
The study found 122 "best" hospitals with high quality and low costs. Those best hospitals were more likely to be in the Northeast, to be nonprofit and to have cardiac intensive care units compared to the worst hospitals.
Elderly blacks made up 15 percent of patients in the worst hospitals and about 7 percent in the best hospitals. There were similar differences for people on Medicaid, the state-federal health program for the poor. Worst-hospital patients with heart attacks or pneumonia were more likely to die than similar patients at the best hospitals.
Medicare chief called the study valuable, but not completely new. He said the federal government is working to help all hospitals improve.
The health law's so-called "value-based purchasing" rewards hospitals for their rate of improvement, not just for attaining goals. So hospitals that start farther behind can get rewarded for making efforts to catch up. And the law provides money for hospital improvement programs.
For the study, the researchers used data from six sources to determine which hospitals were worst and best. They divided the hospitals into four ranked groups for quality of care and divided them again into four ranked groups for cost.
Of 3,229 hospitals analyzed, 122 were in the top group for quality and also in the group that had the lowest costs. The researchers compared those hospitals to the 178 that were in the bottom group for quality and had the highest costs.
With the health law's expansion of insurance in 2014, patients may have more choice in hospitals. But most patients don't use tools like Hospital Compare to find the best ones nearby. Hospital Compare is a government website that rates how hospitals measure up to certain standards, such as giving heart attack patients aspirin.
People go to hospitals because they've always gone there or their families have always gone there or their doctors have always referred them there.
One person of the American Hospital Association said the group is worried about whether the new funding formula will put safety net hospitals at financial risk, but believes all hospitals can improve.

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