Lowest Quality Care Goes to Poor, Minority Patients

Cheryl Clark, for HealthLeaders Media , October 7, 2011

Jha does not think the solution is to do away with value-based purchasing incentives. On the contrary, he said.

"The issue is about holding people accountable."

"What we should be focused on is two-fold. One, we should make sure that we track the impact of VBP in a thoughtful way, and measure whether this is having a positive or negative effect on disparities. But two, we also should be investing a lot more in helping these hospitals improve," he said. If the system does nothing to help them, "you will have a bunch of losers, hospitals that will fail over time, and many will shut down. But over that time, there will be thousands of patients who die needlessly," Jha said.

"We have to have accountability and we have to have pay for performance. But we also have to be aware of the real-life consequences of these policies."

The Harvard researchers used six sources to compile their list of the best and worst hospitals. They included the 2007 HospitalCompare data, the 2005 Medicare Provider Analysis and Review (MedPAR) file linked with the 2005 Medicare Beneficiary File, the American Hospital Association's annual survey of hospitals, the 2007 Medicare Impact file created by CMS, the 2007 Area Resource File with county-level poverty rates and the 2008 HCAHPS survey.

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