30 Oct Penalties for Readmissions Widens Financial Losses At Delta Safety Net Hospitals
MedicalResearch.com Interview with:
Dr. Chen
Hsueh-Fen Chen, Ph.D.
Associate Professor
Department of Health Policy and Management
College of Public Health
University of Arkansas for Medical Sciences
Little Rock, AR 72205
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Centers for Medicare and Medicaid Services announced the Hospital Readmissions Reduction Program (HRRP) and Hospital Value-based Purchasing (HVBP) Program in 2011 and implemented the two programs in 2013. These two programs financially motivate hospitals to reduce readmission rates and improve quality of care, efficiency, and patient experience. The Mississippi Delta Region is one of the most impoverished areas in the country, with a high proportion of minorities occupying in the region. Additionally, these hospitals are safety-net resources for the poor. It was largely unknown what the financial performance for the hospitals in the Mississippi Delta Region was under the HRRP and HVBP programs.
Dr. Chen and colleagues in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences compared the financial performance between Delta hospitals and non-Delta hospitals (namely, other hospitals in the nation) from 2008 through 2014 that were covered before and after the implementation of the HRRP and HVBP programs. The financial performance was measured by using the operating margin (profitability from patient care) and total margin (profitability from patient care and non-patient care)
Before the implementation of the HRRP and HVBP programs, Delta hospitals had weaker financial performance than non-Delta hospitals but their differences were not statistically significant. After the implementation of the HRRP and HVBP programs, the gap in financial performance between Delta and non-Delta hospitals became wider and significant. The unadjusted operating margin for Delta hospitals was about -4.0% in 2011 and continuously fell to -10.4% in 2014, while the unadjusted operating margin for non-Delta hospitals was about 0.1% in 2011 and dropped to -1.5% in 2014. The unadjusted total margin for Delta hospitals significantly fell from 3.6% in 2012 to 1.1% in 2013 and reached 0.2% in 2014, while the unadjusted total margin for non-Delta hospitals remained about 5.3% from 2012 through 2014. After adjusting hospital and community characteristics, the difference in financial performance between Delta and non-Delta remained significant.
MedicalResearch.com: What should readers take away from your report?
Response: Delta hospitals are safety-net resources and an essential part of the health care delivery system for the people in the Mississippi Delta region. While the quality of care is improved nationwide from time to time, Delta hospitals are likely to get left behind and continuously receive penalties because they have few resources to improve quality of care due to the poor financial performance. The widening gap in financial performance between Delta and non-Delta hospitals under the HRRP and HVBP programs is likely to widen disparity in care between Delta and non-Delta regions.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response:The future studies for investigating disparity in quality of and access to care between Delta and non-Delta regions are highly recommended.
Disclosures: No potential conflicts of interest are reported
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Chen, Hsueh-Fen PhD*; Karim, Saleema PhD*; Wan, Fei PhD†; Nevola, Adrienne MPH*; Morris, Michael E. PhD*; Bird, T. Mac PhD*; Tilford, J. Mick PhD*
Medical Care: November 2017 – Volume 55 – Issue 11 – p 924–930
doi: 10.1097/MLR.0000000000000808
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on October 30, 2017 by Marie Benz MD FAAD