Health Care Costs and Financing

Hospitals serving the uninsured and underserved need help with public reporting and pay-for-performance measures

The trend for hospitals to publicly report their data and be paid by insurers for how well they perform is a manageable chore for well-staffed hospitals. But safety-net hospitals, which serve large numbers of impoverished Medicaid clients or are located in rural areas, find that task burdensome. A research team at the University of California at San Francisco conducted interviews with 37 executives from safety-net hospitals to determine their challenges with and solicit recommendations for reporting performance. Executives identified two clear benefits in reporting the information.

First, data could be used to identify where improvements could be made. Second, they said reporting performance data addressed the concerns of consumers and public officials about hospital quality. These groups might question the hospitals' quality if safety net hospitals chose not to report performance data while other hospitals were reporting. Hospital executives also voiced several concerns, mostly about inadequate staffing and data accuracy. For most of the hospitals, staff tasked with coding data did so as an additional duty. They often lacked the training and the time to do the job well.

The researchers recommend that safety-net hospitals be offered grants to implement electronic records or subsidized training for data collectors, or share data collection personnel. The executives also said financial incentives for reporting did not have the same effect for them as other hospitals.

Because their customers do not have a choice of where to get their health care, reporting performance data would not increase their patient volume or profits as it might for other hospitals. Rural hospitals were especially concerned that, because of their small sample sizes, their statistics would appear worse than they were. For example, if one patient with kidney failure was admitted and died, they would have to report a 100 percent fatality rate for that condition.

The researchers recommend letting safety-net hospitals report on special categories that highlight the unique role they play in their communities. This study was funded in part by the Agency for Healthcare Research and Quality (HS16117).

See "Public reporting and pay-for-performance: Safety-net hospitals executives' concerns and policy suggestions," by L. Elizabeth Goldman, M.D., M.C.R., Stuart Henderson, Ph.D., Daniel P. Dohan, Ph.D., and others in the Summer 2007 Inquiry Journal 44, pp. 137-145.

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