Becker's Hospital Review

56 CARE DELIVERY Safety-Net Hospital Patients Have Worse Outcomes Study Suggests 'Intrinsic Qualities' Are to Blame By Heather Punke A new study suggests the "intrinsic qualities" of safe- ty-net hospitals lead to surgical care that is inferior and more expensive. Safety-net hospitals have higher mortality and readmission rates, as well as higher costs associated with surgical care. ese outcomes remained even aer adjusting data for patient charac- teristics and hospital procedure volume, according to the study published in JAMA Surgery. "ese outcomes are likely owing to hospital resources and not necessarily patient factors. In addition, impending changes to reimbursement may have a negative effect on the surgical care at these centers," the study concludes. Researchers examined 231 hospitals and more than 12.6 million patient encounters using data from the University HealthSystem Consortium and CMS' Hospital Compare web- site. ey found safety-net hospitals had lower performance on Surgical Care Improvement Project measures, higher rates of surgical complications and poorer performance on emergency department timeliness measures, possibly as a result of inefficient systems and staffing. In an interview with JAMA Surgery, Shimul Shah, MD, one of the study's authors, said competitive forces will increasingly necessitate that hospitals and providers become "focus factories" or specialize in certain services and close other programs in an effort to be more cost effective. When it comes to this, safety-nets are at a disadvantage. "Safety-net hospitals, though, must care for all patients and are unable to streamline these services to maximize profits so as a result these providers have a limited ability to compete in the… market and are less able to adapt in times of financial stress with- out adversely affecting their patients." Lack of resources at safety-net hospitals may prevent them from pursuing quality improvement initiatives, he said, and "fi- nancial penalties for these providers may further…not induce the desired effect of improving outcomes…but may actually do the opposite in safety-net hospitals." He suggested that reimbursement policies should consider hospital factors in addition to patient outcomes. "I think that ap- propriate risk-adjustment reimbursement policies really need to include the hospital as well as the patient," he said. "Right now, it looks like they're primarily only including the patient and the patient risk factors." n Number of 5-Star Hospitals Decreases Dramatically in CMS Hospital Compare By Heather Punke C MS updated its Hospital Compare database Oct. 8 with new patient experience survey results, and the number of hospitals receiving a five-star HCAHPS summary rating is down significantly since the last update in July. When the ratings first went live in April, 251 hospitals earned the highest available rating of five stars. When the data were updated in July to reflect HCAHPS scores gath- ered from October 2013 through September 2014, that number shot up to 336. Now, however, with HCAHPS data from January 2014 through December 2014, just 207 hospitals out of 3,539 earned a five-star HCAHPS summary star rating. The following is a breakdown of the new star rating distribution: • One star: 76 hospitals (121 hospitals prior) • Two stars: 638 hospitals (475 hospitals prior) • Three stars: 1,531 hospitals (1,320 hospitals prior) • Four stars: 1,087 hospitals (1,296 hospitals prior) • Five stars: 207 hospitals (336 hospitals prior) CMS plans to update data and star ratings quarterly. Even though the American Hospital Association has urged CMS to rethink how the agency generates these star ratings and there has been backlash from industry leaders, CMS does not have plans to change the summary star rating formula, according to CMS.n

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