Safety-net hospitals are uniquely vulnerable under programs that reward and penalize healthcare providers on quality performance. Is there any way to shield their already thin margins from increasing financial pressures?
Safety-net hospitals are bedrocks to the communities they serve, often providing uncompensated care to the most vulnerable, including the uninsured and underinsured, as well as a large population of Medicaid patients. Within these communities are "super-utilizers," or patients who frequent the emergency room for acute care but fail to maintain health after being discharged from the hospital, thus perpetuating the cycle of exorbitant utilization.
However, federal programs like the Medicare Hospital Readmission Reductions Program — which was authorized in 2010 under the Affordable Care Act in an effort to link Medicare reimbursement to hospital performance on quality measures — do not consider certain socioeconomic factors that affect patient outcomes, regardless of quality of care provided in the hospital, according to a recent blog post on Health Affairs. Poverty, health literacy, housing and the availability of social support all influence a patient's likelihood to be readmitted to the hospital, but are not adjusted for under the program.
To reduce the adverse impact of the HRPP penalty on safety-net hospitals without supporting lower-quality care, the Medicare Payment Advisory Commission has proposed a revision to the method for calculating readmissions penalties. The commission suggests categorizing hospitals into peer groups, each with its own readmissions target.
Other efforts aim to amend the structure of the HRPP. For instance, some say the 30-day readmission period is arbitrary. They suggest a shorter window — such as seven days — would more closely reflect the quality of care provided at the hospital, whereas the 30-day period is more of a reflection of the local community's resources.
The healthcare of over-utilizers and those who have frequent readmissions to the hospital could also be improved by increased coordination of care between healthcare providers and social services organizations, as well as the integration of medical and behavioral healthcare services, according to the report.
As the healthcare industry continues its push toward rewarding hospitals for value rather than volume, it will be imperative to monitor safety-net hospitals and their financial vulnerability.