"Hospitals in the highest disproportionate share hospital index quartile share (a measure of federal subsidy for hospitals that treat the poor) had about 40% lower margins...than hospitals in the lowest DSH index quartile," they wrote.
During debates about the value-based purchasing formula, safety net hospitals complained during federally-sponsored open door forums that their patients were sicker and thus less likely to give favorable responses to the HCAHPS survey.
They argued that they were being placed at a disadvantage and deserved an adjustment to take into consideration poverty, language barriers and cultural issues specific to inner city or more dilapidated hospitals.
Their request for an adjustment was not granted because, argued officials for the Centers for Medicare & Medicaid Services, patients at some safety net hospitals working under similar adverse conditions do respond most positively to their HCAHPS surveys. If some hospitals can do it, then all could, they reasoned.
Jha disagrees that there should be any adjustment.
"I think that ultimately, all patients deserve good patient-centered care, so this is not an issue for adjustment. This is an issue for developing a strategy to get these hospitals to improve," he says.