Limited resources doom safety-net hospital surgical outcomes

Safety-net hospitals experience higher mortality, complication and readmission rates--along with higher costs--for nine common elective surgical procedures, a new study finds.

The poorer outcomes are likely caused by limited hospital resources rather than by the sicker, at-risk population being served, according to the study published in JAMA Surgery. The situation is likely to worsen because of impending Medicare reimbursement penalties for poor quality performance, researchers said, putting safety-net hospitals at financial risk.

The study examined outcomes for nine surgical procedures at 231 hospitals, for a total of 12.6 million patient encounters. For 7 out of 9 procedures, hospitals with a high safety-net burden had the highest proportion of emergency cases and the longest lengths of stay. Mortality rates were higher following three procedures, and cost of care higher for 7 out of 9 procedures.

"These data suggest that intrinsic qualities of safety-net hospitals lead to inferior surgical outcomes and increased cost across [nine] elective surgical procedures," the researchers concluded.

Patients living in poor neighborhoods are at greater risk for complications, the researchers acknowledged. One 2014 study found, for example, that heart-failure patients living in poverty are significantly more likely to be readmitted within six months than their wealthier neighborhoods.

But the negative outcomes were higher even when researchers adjusted for the patient population, study co-author Shimul Shah, M.D., said in an audio interview discussing the findings.

Researchers cautioned that "universally applied reimbursement penalties may not be the ideal technique" for promoting better quality and lower healthcare costs, and are more likely to have the opposite effect while exacerbating racial disparities in care. "Perhaps a better solution would be to invest in these hospitals to improve quality and efficiency," they said.

For more:
- read the study abstract
- listen to the interview