Quality of care at safety‐net hospitals and the impact on pay‐for‐performance reimbursement

Background 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 objecti...

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Bibliographic Details
Published in:Cancer 2020-10, Vol.126 (20), p.4584-4592
Main 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.
Format: Article
Language:English
Subjects:
Cancer
cancer care metrics
Government programs
health care disparities
Health risks
Hospitals
Medicaid
Oncology
Patient safety
Patients
pay‐for‐performance reimbursement
quality of cancer care
Safety
safety‐net hospitals
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Summary:Background 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. Methods 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. Results 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 
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.33137