The idea that the Patient Protection and Affordable Care Act, which was written in part to strengthen the healthcare safety net, may end up punishing the very providers who take care of the poor by imposing unfair payment algorithms, is ironic.
It reminds me of Catherine Kutzler's lament.
She's the CEO of poor St. Joseph's Hospital in Philadelphia. When the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey was updated in May, it showed her 146-bed facility had the third worst patient experience scores in the country, including whether patients "would recommend" St. Joseph's to family and friends.
"This is a very old hospital," she sighed. "We receive a lot of complaints about our rooms. They're old and they look dirty no matter what we do."
Also hurting her scores is the fact that the building is in a poor part of town. Many patients can't pay. She couldn't get qualified emergency department nurses and salaries aren't comparable. Many of the doctors are older and may be perceived as being out of touch.
And many of their patients have drug-seeking or mental health issues that make St. Joseph's other patients uncomfortable. "I've been here since 1990 and the community has always viewed this hospital as one that just takes care of the poor," she said.
Nearly two and a half years after the law's passage, researchers, clinicians and public hospital officials are seeing that unintended consequences of the law may punish these hospitals for conditions that are out of their control, impeding their ability to care for the sickest and poorest patients, and contributing to a downward institutional spiral.