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Quality Lags at Safety-Net Hospitals
Date:5/13/2008

d 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.

This means that there was a 39 percent difference between safety-net and non-safety-net hospitals in caring for heart attack patients. The same pattern was repeated in the other conditions looked at, which included heart failure and pneumonia.

Moreover, hospitals, with a high percentage of Medicaid patients were less likely to be ranked by the U.S. Centers for Medicare and Medicaid Services as top performers. In fact, hospitals with a high percentage of Medicaid patients saw their quality ratings drop from 10.1 percent in 2004 to 2.8 percent in 2006, the researchers found.

At the same time, hospitals that treat a low percentage of Medicaid patients saw their quality ratings increase from 13.6 percent to 19.7 percent across all three medical conditions measured.

Werner thinks the solution to these problems is to provide safety-net hospitals with government funding specifically targeted to improving the quality of care. "The financial incentives should be restructured to reward improvement efforts, rather than achievement, safety-net hospitals could benefit," she said.

If the situation doesn't improve, the disparity between hospitals will only worsen, Werner said.

"This is concerning, because there are people who rely on these hospitals for their care, and ultimately you end up penalizing those patients by allowing this disparity to widen," Werner said. "It's possible that some of these hospitals will be forced to close. And this is a concern, because they provide an avenue of health care for many people who can't go elsewhere."

One expert also thinks the government needs to take the lead in improving the quality of care in safety-net hospita
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