CHICAGO (AP) — The nation's worst hospitals treat
twice the proportion of elderly black patients and poor patients than the best
hospitals, and their patients are more likely to die of heart attacks and
pneumonia, new research shows.
Now, these hospitals, mostly in the South, may be
at higher risk of financial failure, too. That's because the nation's new health
care law punishes bad care by withholding some money, says the lead author of
the study published Wednesday in the journal Health Affairs.
"These hospitals are going to have a much
harder time in the new funding environment," said Dr. Ashish Jha of the
Harvard School of Public Health, who led the study. "I worry they're going
to get worse over time and possibly even fail. I worry that we're going to see
a bunch of that happening over next three to five years."
Under the Affordable Care Act, hospitals that fail
to improve will see their Medicare payments shrink by 1 percent starting
October 2012. That could jeopardize some hospitals already on the brink of
closure, Jha said.
That unintended consequence of the health overhaul
could increase health disparities for minorities, Jha said.
"We have to make sure we pay attention to what
the results of those policies are and be ready to change directions if they're
causing harm in the marketplace," Jha said.
The study doesn't name the 178 hospitals the researchers
rated as "worst" because of their low quality of care and high costs.
A data use agreement with Medicare prevented the researchers from identifying
the hospitals publicly.
The study, funded by the Commonwealth Fund, found
122 "best" hospitals with high quality and low costs. Those best
hospitals were more likely to be in the Northeast, to be nonprofit and to have
cardiac intensive care units compared to the worst hospitals.
Elderly blacks made up 15 percent of patients in
the worst hospitals and about 7 percent in the best hospitals. There were
similar differences for people on Medicaid, the state-federal health program
for the poor. Worst-hospital patients with heart attacks or pneumonia were more
likely to die than similar patients at the best hospitals.
Medicare chief Don Berwick called the study
"valuable, but not completely new." He said the federal government is
working to help all hospitals improve.
"We know they can improve," even if they
treat sicker or disadvantaged patients, Berwick said. "There are examples
of safety net hospitals that are some of the best in the country." He
cited Denver Health, which has low death rates despite treating a large share
of poor patients.
The health law's so-called "value-based
purchasing" rewards hospitals for their rate of improvement, not just for
attaining goals, Berwick said. So hospitals that start farther behind can get
rewarded for making efforts to catch up. And the law provides money for
hospital improvement programs.
"If I were talking to safety net hospitals, I
would say, 'I know it's hard. Here's some help, and if you start (improving),
you'll get rewarded for starting,'" Berwick said.
For the study, the researchers used data from six
sources to determine which hospitals were worst and best. They divided the
hospitals into four ranked groups for quality of care and divided them again
into four ranked groups for cost.
Of 3,229 hospitals analyzed, 122 were in the top
group for quality and also in the group that had the lowest costs. The researchers
compared those hospitals to the 178 that were in the bottom group for quality
and had the highest costs.
"What can we do to take the lessons from the
high-performing institutions and help the low performers improve?" Jha
asked. In markets outside of health care, business closures don't so directly
affect people's survival, he said, but "here, there are tens of thousands
of lives at stake."
With the health law's expansion of insurance in
2014, patients may have more choice in hospitals. But most patients don't use
tools like Hospital Compare to find the best ones nearby, Jha said. Hospital
Compare is a government website that rates how hospitals measure up to certain
standards, such as giving heart attack patients aspirin.
"People go to hospitals because they've always
gone there or their families have always gone there or their doctors have
always referred them there," Jha said.
Nancy Foster of the American Hospital Association
said the group is worried about whether the new funding formula will put safety
net hospitals at financial risk, but believes all hospitals can improve.
"There's no hospital in the country right now
that doesn't want to do the best for the patients it serves," Foster said.
"That's where research comes in and sharing of good results on how to
improve."
Copyright 2011 The Associated Press.
