Hospitals that care for uninsured or underinsured patients experience decreased quality of care measures, which could decrease hospital payments under pay-for-performance reimbursement models (Cancer. 2020. doi:10.1002/cncr.33137).
“Pay‐for‐performance reimbursement ties hospital payments to standardized quality‐of‐care metrics,” explained Reith R. Sarkar MD, MAS, Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, and colleagues.
“To the authors' knowledge, the impact of pay‐for‐performance reimbursement models on hospitals caring primarily for uninsured or underinsured patients remains poorly defined,” they continued.
Dr Sarkar and colleagues conducted a study to evaluate how a hospital’s propensity to care for uninsured or underinsured patients effects standardized quality of care metrics with an aim to demonstrate the potential impact pay-for-performance reimbursement could have on these hospitals caring for the underserved.
A total of 1,703,865 patients diagnosed with cancer between 2004 and 2015 and treated at 1344 hospitals were identified and included in the study.
Hospital safety‐net burden was defined as the percentage of uninsured or Medicaid patients cared for by that hospital. Hospitals were categorized into 3 categories: low‐burden, medium‐burden, and high‐burden.
Dr Sarkar and colleagues examined the impact of safety‐net burden on concordance with 20 standardized quality‐of‐care measures, adjusting for differences in patient age, sex, stage of disease at diagnosis, and comorbidity.
High-burden hospitals had lower adherence to 13 to 20 quality measures compared with low-burden hospitals. Among 350 high-burden hospitals, concordance with quality measures was found to be the lowest for those caring for the highest percentage of uninsured or Medicaid patients, minority patients, and less educated patients.
“Hospitals caring for uninsured or underinsured individuals have decreased quality‐of‐care measures,” Dr Sarkar and colleagues concluded.
“Under pay‐for‐performance reimbursement models, these lower quality‐of‐care scores could decrease hospital payments, potentially increasing health disparities for at‐risk patients with cancer,” they added.—Janelle Bradley
