Lowest Quality Care Goes to Poor, Minority Patients

Harvard researchers who identified 178 hospitals that provide the lowest quality of care yet have the highest cost also found that these facilities treat a higher proportion of poor, aged, and minority patients than 122 hospitals that provide high quality and lower-cost care.

Unfortunately, the very programs designed to incentivize higher quality, specifically the federal value-based purchasing incentives set forth by the Affordable Care Act, "will have a disproportionately negative effect on these hospitals unless we figure out a way to help them improve," lead author Ashish, Jha, an associate professor of health policy at the Harvard school of Public Health said in a telephone interview.

Jha said the incentives will put a "double-squeeze on these hospitals" to come up with improvements -- a challenge that will be especially tough for them to accomplish -- or risk financial penalties. 

Jha is the lead author of a paper published this week in the October issue of Health Affairs. This month's edition is devoted to correcting disparities in healthcare delivery system.

His report found that the worst hospitals – "typically small ,public or for-profit institutions in the South – care for double the proportion (15% versus 7%) of elderly black patients as the 'best' hospitals, typically nonprofit institutions in the Northeast." 

The specific hospitals were not named. But Jha said that his "sense is that these hospitals haven't paid attention to quality, and they're also financially stressed. And when you're financially stressed, you focus more on survival than on making sure quality of care is good."