News & Commentary

Safety-Net Hospitals Need More TLC


Frank Diamond

CMS penalties for early readmission at hospitals continues to make waves, and some sections of the industry may be swamped as a result, according to authors of a study in JAMA Surgery that doesn’t put safety-net hospitals in the most positive light.

Safety-net hospitals, often located in urban and rural areas, must care for all patients regardless of their ability to pay.

The University of Cincinnati College of Medicine researchers looked at how well 231 hospitals performed nine elective surgical procedures from January 2009 through December 2012.

Sifting through 12.6 million patient encounters, the researchers found that “safety-net hospitals lead to inferior surgical outcomes…” and increased costs for the nine procedures.

For seven of the procedures, the safety-net hospitals had the longest length of stay and the biggest proportion of emergency cases. Those procedures were coronary artery bypass graft, colectomy, hip replacement, kidney replacement, knee replacement, pulmonary lobectomy, and ventral hernia repair. The hospitals had the highest mortality rates for three procedures: colectomy, pancreaticoduodenectomy (the Whipple procedure), and ventral hernia repair.

Going into this study, the researchers had hypothesized that the safety-net hospitals would have worse outcomes and be more expensive, but they figured those results would be explained by the patient populations being sicker and poorer. When they analyzed the data they found that the differences persisted even after adjustment for factors like socioeconomic status and severity of illness.

The researchers noted, though, that safety-net hospitals struggle with limited resources that may prevent them from investing in efforts that would improve outcomes and curb costs. Their takeaway is that financial penalties for poor performance and results such as high readmission rates could be counterproductive.