Hospitals for poor may struggle further under health care reform

Health

more>>

Facebook users really 'liked' organ donor option

Adding an organ donation option to the average Facebook user's profile prompted a dramatic rise in potential donors, researchers report.

Could 'moderate' drinking be safe during pregnancy?

Children of women who drink moderate amounts of alcohol while pregnant don't appear to have any neurodevelopmental problems when it comes to balance, a new British study suggests.

Concussion damage looks much like early Alzheimer's

Concussion can lead to damage in the white matter of the brain that resembles abnormalities found in people in the early stages of Alzheimer's disease, a new study suggests.

Many Americans want health care via smartphone

Plenty of Americans are eager to use their mobile phones and tablet computers to better manage their health care, a new poll finds -- though the nation has a way to go before we're all consulting Dr. Smartphone.

Scans uncover dangerous hardening of abdominal aorta

People with a "hardening" of the abdominal aorta are at increased risk for heart attack and stroke, according to a new study.

Minority kids with autism less likely to use specialty services

Black and Hispanic children with autism are markedly less likely than children from white families to receive specialty care for complications tied to the disorder, a new study finds.

Skipping breakfast may raise diabetes risk

Eating breakfast every day may help overweight women reduce their risk of diabetes, a small new study suggests.

Tobacco laws for minors may cut adult smoking as well

Strict controls on the sale of cigarettes to youth may also reduce adult smoking, a new study suggests.

Sibling bullying can lead to depression, anxiety in victims

Being picked on by your brother or sister may seem like a normal part of growing up, but for some kids the bullying may be a source of depression and anxiety, a new study suggests.

Video gamers may have better visual recall

In a new finding sure to be shared with some skeptical parents, it seems that the brains of video game enthusiasts make better and faster use of visual input.

By Randy Dotinga
HealthDay Reporter

TUESDAY, July 17 (HealthDay News) -- A new study finds that so-called "safety-net" hospitals that serve the poor do a worse job overall than other hospitals, a potentially big problem as health care reform boosts the number of people who have insurance and more choice about where they can go for care.

Medicare used to give these hospitals extra payments for taking care of poor people. But under health care reform, they'll get less of that funding and more for how they perform on a variety of measurements, including how patients rate them.

"Our results suggest that safety-net hospitals are struggling on this important metric. As a result, safety-net hospitals are likely to get penalized under the new payment scheme," said Paula Chatterjee, a medical student at Harvard School of Public Health. "Given that safety-net hospitals are already financially stretched, even small losses can be potentially devastating for these hospitals."

At issue are hospitals that serve poor people, often including those who don't have health insurance. According to the study, they tend to be sicker than other patients and have less trust in the health care system.

Under health care reform, the federal government punishes hospitals that perform poorly on a variety of measures by not giving them some Medicare payments.

The researchers studied 3,096 hospitals and examined answers that patients gave to surveys about their experiences at the hospitals. The safety-net hospitals -- 769 of the total -- were slightly less likely than other hospitals to be in urban areas (many are in rural parts of the country), much more likely to serve Medicaid patients and more likely to have fewer nurses per patient.

The safety-net hospitals had the lowest overall rating among patients and ranked a bit lower in the patient perception of things such as communication with medical staff and management of their condition.

"Safety-net hospitals are a critical part of our health care system. They provide care to everyone, irrespective of the patient's ability to pay. The new payment scheme, which ties part of the hospital payments to how those hospitals do on patient-reported scores, is laudable in its goals," Chatterjee said. "Our paper says that under the new scheme, safety-net hospitals are likely to do poorly. We need new strategies to help these hospitals improve."

What could be done? Chatterjee said Medicare should work with hospitals to help them do a better job of caring for patients. "Given the challenges of caring for a relatively poor population and the low reimbursement rates, we suspect that many hospitals have not been able to focus on optimizing patient experience," she said. "It's time to help these hospitals do so."

In a commentary, Dr. Katherine Neuhausen, a physician at the University of California, Los Angeles, and Dr. Mitchell Katz, director of the Los Angeles County Department of Health Services, wrote that the federal government should try to help the hospitals instead of adding pressure. One way to do that, they write, is to give more money to the hospitals that perform well instead of penalizing those that don't.

The study appeared online July 16 in the Archives of Internal Medicine.

More information

To compare the quality of hospitals, try the federal government's Hospital Compare website.

*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.