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- Title
Quality of care at safety-net hospitals and the impact on pay-for-performance reimbursement.
- Authors
Sarkar, Reith R.; Courtney, P. Travis; Bachand, Katie; Sheridan, Paige E.; Riviere, Paul J.; Guss, Zachary D.; Lopez, Christian R.; Brandel, Michael G.; Banegas, Matthew P.; Murphy, James D.
- Abstract
<bold>Background: </bold>Pay-for-performance reimbursement ties hospital payments to standardized quality-of-care metrics. To the authors' knowledge, the impact of pay-for-performance reimbursement models on hospitals caring primarily for uninsured or underinsured patients remains poorly defined. The objective of the current study was to evaluate how standardized quality-of-care metrics vary by a hospital's propensity to care for uninsured or underinsured patients and demonstrate the potential impact that pay-for-performance reimbursement could have on hospitals caring for the underserved.<bold>Methods: </bold>The authors identified 1,703,865 patients with cancer who were diagnosed between 2004 and 2015 and treated at 1344 hospitals. Hospital safety-net burden was defined as the percentage of uninsured or Medicaid patients cared for by that hospital, categorizing hospitals into low-burden, medium-burden, and high-burden hospitals. The authors evaluated the impact of safety-net burden on concordance with 20 standardized quality-of-care measures, adjusting for differences in patient age, sex, stage of disease at diagnosis, and comorbidity.<bold>Results: </bold>Patients who were treated at high-burden hospitals were more likely to be young, male, Black and/or Hispanic, and to reside in a low-income and low-educated region. High-burden hospitals had lower adherence to 13 of 20 quality measures compared with low-burden hospitals (all P < .05). Among the 350 high-burden hospitals, concordance with quality measures was found to be lowest for those caring for the highest percentage of uninsured or Medicaid patients, minority patients, and less educated patients (all P < .001).<bold>Conclusions: </bold>Hospitals caring for uninsured or underinsured individuals have decreased quality-of-care measures. Under pay-for-performance reimbursement models, these lower quality-of-care scores could decrease hospital payments, potentially increasing health disparities for at-risk patients with cancer.
- Subjects
SAFETY-net health care providers; HOSPITAL care quality; REIMBURSEMENT; MEDICALLY uninsured persons; HOSPITAL care; HEALTH equity; MEDICAL quality control; LABOR incentives; RESEARCH funding; PAY for performance
- Publication
Cancer (0008543X), 2020, Vol 126, Issue 20, p4584
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.33137