On nearly every measure of the Hospital Consumer Assessment of Health Plans Survey patient experience questionnaire, 769 hospitals that treat the largest share of low-income patients scored 5.6 percentage points lower than their 2,327 non-safety net counterparts, according to a review of survey responses between 2007 and 2010.
"What we found was that these safety net hospitals generally do worse on this measure, and I don't think we knew that before we did our work," says Ashish Jha, MD, corresponding author for the study published in Tuesday's Archives of Internal Medicine.
The finding is critically important. A key section of the Patient Protection and Affordable Care Act mandates that those survey response scores now influence how much hospitals are paid for Medicare patient care starting Oct. 1.
Past survey scores over a three-year period influence a significant chunk of each hospital's value-based purchasing incentive payment. The maximum penalty as of Oct. 1 is 1% of a hospital's Medicare DRG payments but rises to 2% by 2017.
If large numbers of a hospital's patients say their doctors and nurses "always" answered their questions, that their pain was "always" well controlled, and said that their room and bathroom were "always" clean, the survey responses influence just under one-third of that 1% to 2%.
But scores at safety net hospitals, which are more likely to be old, look unclean, or have a more run-down appearance, could be influenced by factors that are beyond the hospital's immediate control.