Beth Feldpush, of the National Association of Public Hospitals and Health Systems, has supported the use of tools such as HCAHPS to improve quality. But now she's not so sure.
"Now, I think, the tool is just new enough that we are just starting to learn potential limitations to it, and refinements that could be made," she says.
In my interviews with health policymakers and executives, I've heard these themes about how the law, as it now must be implemented, may place safety net hospitals at an unfair disadvantage, potentially perpetuating some of the very problems the healthcare law was supposed to fix. Their complaints fit into seven categories.
1. Higher rates of readmissions
There's substantial evidence that safety net hospitals have a tougher time preventing readmissions than non-safety net hospitals, and will be penalized up to 1% starting Oct. 1, up to 2% starting Oct. 1, 2013 and up to 3% starting Oct. 1, 2014 and beyond.
Mitchell Katz, MD, head of the Los Angeles County Department of Health Services, which runs four safety net hospitals with nearly 1,500 beds, says poor family support at home for meals, problems with transportation, and medication non-adherence impede the ability of safety net patients to make it on their own after discharge.
"Two people get discharged after treatment for pneumonia. One has family that can cook and bring liquids, has a warm home, people who visit and help with medications. The other lives alone in a single room occupancy hotel. Who's more likely to be readmitted?" he asks.