Feldpush says approximately 200 safety net hospitals represent about 2% of all hospitals in the United States. However, they would absorb 15% of the cap reductions—a $150 million hit—owing to their patient mix, high facilities and operations costs, and a care delivery structure that relies heavily on outpatient clinics.
"That's 15% of $1 billion: 200 hospitals; 2% of hospitals; 15% of the cuts. That is a lot," Feldpush says. "You could pretty much say that it would be incredibly challenging to stake an institution to cuts of that magnitude without seeing negative consequences in terms of the services we could offer and the people we could serve."
Much of that disproportionate hit comes because large safety net hospitals in urban settings rely on extensive ambulatory care networks. "Among NAPH member hospitals, they have on average 20 outpatient clinics. This is intentional. We manage those hard-to-reach patient populations with very complex multiple co-morbidities," Feldpush says.