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7 Ways the PPACA Hurts Safety Net Hospitals

Cheryl Clark, for HealthLeaders Media, July 19, 2012

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.

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2 comments on "7 Ways the PPACA Hurts Safety Net Hospitals"


Bulldog (7/20/2012 at 9:19 PM)
1) Unless Republican governors choose to give away Medicaid funds in order to score political points, PPACA is a huge boon for safety net hospitals. Higher reporting requirements are annoying, certainly, as are reward payments that may not capture the challenges of being a safety net hospital, but drastically increased insurance rates are a massive bonus to hospitals that currently provide so much uncompensated care. 2) Mr. Plemmons: I defy you to describe one specific way in which PPACA is a "massive government takeover." Does Medicare not paying for readmissions constitute a takeover? Having insurers compete in state-based exchanges a takeover?

Patrick Plemmons (7/19/2012 at 3:40 PM)
Gee, who knew that a massive government takeover of the healthcare system could have unintended consequences? Someone should alert the AHA, CHA and all the other organizations that sold their constituents down the river in return for more volume. Volume, by the way, that will be under reimbursed, but I guess that was unintended too.