For this study, the researchers analyzed data from 618 acute care facilities (including 145 safety-net hospitals) across the country that reported data to the National Healthcare Safety Network and had implemented HACRP and HBVP between 2013 and 2018. The specific health care-associated infections investigated in this study were: central line-associated bloodstream infections; catheter-associated urinary tract infections; and surgical site infections after colon surgery and abdominal hysterectomy.
The results showed that neither safety-net nor non-safety-net hospitals showed improvements in the four infections analyzed during the study period, including after the value-based programs were implemented. Safety-net hospitals had higher rates of central line-associated bloodstream infections, catheter-associated urinary tract infections and surgical site infections after colon surgery compared with non-safety-net hospitals both before and after value-based program implementation.
Insurance coverage provided through Medicaid and Medicare, while critical, does not typically cover the actual cost of care. This results in safety-net hospitals relying on supplemental government funding to continue to provide necessary health care services to patients. At the present time, the availability of these uncompensated care funds is decreasing, and could be eliminated, which would have a detrimental impact on safety-net hospitals and other health care systems.
"Right now, the programs are not leading to any meaningful improvements in patient safety and are contributing to inequity in our health care system by disproportionately penalizing safety-net hospitals," added Hsu, assistant professor of pediatrics at Boston University School of Medicine. "We hope that these results can serve as a starting point to re-evaluate and re-design value-based incentive programs."
The researchers note that adding in a social risk factor adjustment before assessing penalties based on reported outcomes data may help avoid systematic penalization of safety-net hospitals without setting lower quality standards in these institutions.
Funding for this study was provided by the Agency for Healthcare Research and Quality.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $97 million in sponsored research funding in fiscal year 2018. It is the 15th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston.
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