CMS Medicare Reimbursement for Quality Care: Will There Be an Unintended Downward Spiral for Safety Net Hospitals?

• Activity Number: 285
• Type: Contributed
• Date/Time: Tuesday, August 4, 2009 : 8:30 AM to 10:20 AM
• Sponsor: Section on Health Policy Statistics
• Author(s): Ronald Low*+ and Shunsuke Ito and Jiaying Wu and Caroline Jacobs and Raymond Gregory and Van Dunn and Ramanathan Raju
• Companies: New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation and New York City Health and Hospitals Corporation
• Keywords: Health care ; Medicare ; CMS ; Reimbursement ; GEE ; AHRQ

Abstract

Medicare now measures hospital "quality." Beginning this year, they will adjust reimbursement, paying more for better care. Werner, in JAMA, showed lower quality in safety net hospitals, which care for indigents. She posits an unintended downward spiral of lower reimbursement and worsening care. We used yearly published performance of the 20 "Core Measures" for New York City Hospitals. We divide hospitals into City Government (C), other safety net (S), and non-safety net (N). We used GEE to look for differences between the groups, changes over time, and interactions. There were improvements over time for all but two of the measures, supporting the Medicare's approach. C's performances were equal to or superior to both S and N for all measures. C funding differs from S. The NY City model suggests that some safety net hospitals may do well and avoid the "downward spiral."