Peeking behind those poorer safety net outcomes

A heart attack victim shows up at the emergency room door. He's whisked off to the cardiac catheterization lab where balloon angioplasty opens the blocked arteries, stents are inserted and a life is saved.

But that is only the start of the patient's journey through the healthcare system. The near-term likelihood that he won't return to the hospital—as well as his long-term survival prospects—will depend on a host of factors that are out of the control of inpatient care providers.

Will he show up for his physician appointment the next day? Will he show up at the pharmacy to pick up his prescriptions? Will he take his medicine and follow the precautionary discharge instructions?

In recent years, incentivized by the penalties for excess 30-day readmissions included in the Patient Protection and Affordable Care Act, hospital officials have pursued a number of strategies to ensure compliance with discharge instructions and follow-up care. Many hospitals have shown remarkable progress in bringing down their 30-day readmission rates.

Others have been less successful—in particular, safety net hospitals that provide care for many of the nation's poor, unemployed and uninsured, who are disproportionately black and Hispanic. This year's special analysis provided by Truven Health Analytics discovered a direct relationship between the socio-economic status of patients and their outcomes after accessing care.

That translates into higher 30-day readmission rates at the nation's safety net hospitals, as Sabriya Rice reports in this special supplement. It suggests the CMS may be penalizing hospitals for their patient population profile, not their poor performance.

The CMS responds that many safety net hospitals perform well compared to their peers. The government says it's the quality of care that matters, noting some hospitals have figured out how to provide the follow-up social services needed to achieve better outcomes.

Officials must always be vigilant for the unintended consequences of their policies, especially when it comes to using payment to reward outcomes. One way to test the CMS response is to see if some safety net hospitals do better than others in dealing with low socio-economic status patients. It's a question that Modern Healthcare will be seeking answers to in the months ahead.

Follow Merrill Goozner on Twitter: @MHgoozner