In an interview with HealthLeaders Media last week, Bruce Siegel, MD, President and CEO of the National Association of Public Hospitals and Health Systems, described the impact as "a disaster for the safety net and a disaster for patients. You can have a safety net for public hospitals or you can have Medicaid coverage, one or the other, but what's happening is that we are walking away from both."
7. Greater risk of infection
Under the new law, hospitals with higher rates of healthcare-associated infections will receive another downward payment adjustment. This, too, could disadvantage those low-income patients' hospitals that are older and have double rather than single-bed rooms.
"I don't want to suggest that safety net hospitals cause more infections," Katz says. "I just know that any place that doesn't have single rooms has higher rates of infections. And disproportionately, safety net hospitals are more likely to have double or quadruple rooms."
The bottom line, Katz says, is that the ACA's rules are telling his hospitals "we're going to compare you relative to your peer group, even though your peer group is not really equal to you" with hurtful payment reductions that are premature.
Far better, he suggests, is a "carrot and stick" approach that would push hospitals to set up improvement targets that challenged hospitals could strive to reach. "I have no problem with the idea that if you can't demonstrate improvement, payment is withheld. But I don't like pretending that all hospitals have these burdens and should be rated against each other. They don't."