Matlin Gilman, BA; Jason M. Hockenberry, PhD; E. Kathleen Adams, PhD; Arnold S. Milstein, MD; Ira B. Wilson, MD, MSc; Edmund R. Becker, PhD
Disclaimer: All statements in this article, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its board of governors, or its methodology committee.
Grant Support: By the Patient-Centered Outcomes Research Institute Pilot Project Program Award (grant 1IP2PI000167-01).
Disclosures: Mr. Gilman reports grants from the Patient-Centered Outcomes Research Institute during the conduct of the study. Dr. Hockenberry reports grants from the Patient-Centered Outcomes Research Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2813.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Hockenberry (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Jason M. Hockenberry, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322; e-mail, email@example.com.
Current Author Addresses: Mr. Gilman and Drs. Hockenberry, Adams, and Becker: Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322.
Dr. Milstein: Clinical Excellence Research Center, Stanford School of Medicine, 75 Alta Road, Stanford, CA 94305.
Dr. Wilson: Department of Health Services, Policy & Practice, Brown University School of Public Health, Box G-S121-7, Providence, RI 02912.
Author Contributions: Conception and design: M. Gilman, J.M. Hockenberry, E.K. Adams, E.R. Becker.
Analysis and interpretation of the data: M. Gilman, J.M. Hockenberry, E.K. Adams, I.B. Wilson, E.R. Becker.
Drafting of the article: M. Gilman, J.M. Hockenberry, E.K. Adams, A.S. Milstein, I.B. Wilson, E.R. Becker.
Critical revision of the article for important intellectual content: M. Gilman, J.M. Hockenberry, I.B. Wilson, E.R. Becker.
Final approval of the article: M. Gilman, J.M. Hockenberry, E.K. Adams, A.S. Milstein, I.B. Wilson, E.R. Becker.
Statistical expertise: M. Gilman, J.M. Hockenberry, E.K. Adams.
Obtaining of funding: E.R. Becker.
Administrative, technical, or logistic support: M. Gilman.
Collection and assembly of data: M. Gilman, E.R. Becker.
Gilman M, Hockenberry JM, Adams EK, Milstein AS, Wilson IB, Becker ER. The Financial Effect of Value-Based Purchasing and the Hospital Readmissions Reduction Program on Safety-Net Hospitals in 2014: A Cohort Study. Ann Intern Med. 2015;163:427-436. doi: 10.7326/M14-2813
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Published: Ann Intern Med. 2015;163(6):427-436.
Medicare's value-based purchasing (VBP) and the Hospital Readmissions Reduction Program (HRRP) could disproportionately affect safety-net hospitals.
To determine whether safety-net hospitals incur larger financial penalties than other hospitals under VBP and HRRP.
United States in 2014.
3022 acute care hospitals participating in VBP and the HRRP.
Safety-net hospitals were defined as being in the top quartile of the Medicare disproportionate share hospital (DSH) patient percentage and Medicare uncompensated care (UCC) payments per bed. The differences in penalties in both total dollars and dollars per bed between safety-net hospitals and other hospitals were estimated with the use of bivariate and graphical regression methods.
Safety-net hospitals in the top quartile of each measure were more likely to be penalized under VBP than other hospitals (62.9% vs. 51.0% under the DSH definition and 60.3% vs. 51.5% under the UCC per-bed definition). This was also the case under the HRRP (80.8% vs. 69.0% and 81.9% vs. 68.7%, respectively). Safety-net hospitals also had larger payment penalties ($115 900 vs. $66 600 and $150 100 vs. $54 900, respectively). On a per-bed basis, this translated to $436 versus $332 and $491 versus $314, respectively. Sensitivity analysis setting the cutoff at the top decile rather than the top quartile decile led to similar conclusions with somewhat larger differences between safety-net and other hospitals. The quadratic fit of the data indicated that the larger effect of these penalties is in the middle of the distribution of the DSH and UCC measures.
Only 2 measures of safety-net status were included in the analyses.
Safety-net hospitals were disproportionately likely to be affected under VBP and the HRRP, but most incurred relatively small payment penalties in 2014.
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