Quality Lags at Safety-Net Hospitals

By Steven Reinberg
HealthDay Reporter
Wednesday, May 14, 2008; 3:00 AM

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TUESDAY, May 13 (HealthDay News) -- The quality of care at hospitals that treat poor and underserved patients, often called safety-net hospitals, is lagging well behind hospitals that do not serve these patients, a new study finds.

These hospitals, which rely on state and federal funding from Medicaid and other sources, do not have the money to improve the quality of care at the same rate that better-funded hospitals do.

"Safety-net hospitals provide a lower quality of care than non-safety-net hospitals," said lead researcher Dr. Rachel M. Werner, from the Philadelphia VA Medical Center. "Over time, the quality was lower than non-safety-net hospitals."

This is important, because hospital performance determines the funding that many hospitals get under pay-for-performance policies, Werner said. "Hospitals that are doing worse are going to get penalized," she said.

Safety-net hospitals tend to be inner-city and teaching hospitals, Werner noted.

"Finances at safety-net hospitals are often worse than at non-safety-net hospitals," Werner said. "This is because they provide more care to uninsured patients and more care for Medicaid patients. With less money, they have less to put into quality improvement."

Under pay-for-performance, a system that rewards quality care, safety-net hospitals fare worse, Werner added. "You get into a situation where rich hospitals get richer, but the poor hospitals become poorer," she said.

Her report is published in the May 14 issue of the Journal of the American Medical Association.

In the study, Werner's team used data collected between 2004 and 2006 from 3,665 safety-net and non-safety-net hospitals.

The researchers found that hospitals that cater to a low percentage of Medicaid patients had significantly more improvement in quality compared with safety-net hospitals.

For example, hospitals that have a low number of Medicaid patients improved the care of heart attack patients by 3.8 percentage points compared with safety-net hospitals, whose performance improved 2.3 percentage points.