Safety-net hospitals more likely than other hospitals to fare poorly under Medicare's value-based purchasing.
Medicare's value-based purchasing (VBP) program potentially puts safety-net hospitals at a financial disadvantage compared to other hospitals. In 2014, the second year of the program, patient mortality measures were added to the VBP program's algorithm for assigning penalties and rewards. We examined whether the inclusion of mortality measures in the second year of the program had a disproportionate impact on safety-net hospitals nationally. 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. However, safety-net hospitals' performance on mortality measures was comparable to that of other hospitals, with an average VBP survival score of thirty-two versus thirty-one among other hospitals. Although safety-net hospitals are still more likely than other hospitals to fare poorly under the VBP program, increasing the weight given to mortality in the VBP payment algorithm would reduce this disadvantage.
Matlin Gilman is a research assistant in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University, in Atlanta, Georgia.
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E. Kathleen Adams is a professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University.
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Jason M. Hockenberry (jason.hockenberry@emory.edu) is an assistant professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University.
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Arnold S. Milstein is a professor of medicine in the Center for Clinical Excellence at the Stanford University School of Medicine, in California.
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Ira B. Wilson is a professor of Community Health at Brown University, in Providence, Rhode Island.
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Edmund R. Becker is a professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University.
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D016009:Chi-Square Distribution; D016208:Databases, Factual; D005377:Financial Management, Hospital / Q000458:organization & administration*; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000191:economics*; D009203:Myocardial Infarction / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D011785:Quality Assurance, Health Care / Q000191:economics*; D012189:Retrospective Studies; D018570:Risk Assessment; D064876:Safety-net Providers / Q000191:economics* / Q000458:organization & administration; D014481:United States; D062505:Value-Based Purchasing / Q000191:economics* / Q000458:organization & administration
Financing Health Care; Health Reform; Hospitals; Medicare; Safety-Net Systems