Quality penalties to slam high-intensity teaching hospitals

Safety-net hospitals--especially those with significant physician-training programs--are poised to take a major hit from new payment models that penalize hospitals for readmissions, a new study suggests.

Mortality rates for three key diagnoses are lower at hospitals with high-intensity physician training, based on the ratio of residents to patient beds, but readmission rates are higher, researchers reported in the July issue of Medical Care. The variances are significant, the researchers concluded.

"Financial incentives may disproportionately impact the financial health of higher teaching intensity hospitals and safety-net hospitals, particularly with respect to penalties for higher readmission rates" lead author Stephanie K. Mueller, M.D., of Brigham and Women's Hospital in Boston said yesterday in an announcement.

High-intensity teaching hospitals had lower mortality rates than nonteaching hospitals for heart attack and heart-failure patients, even when adjusting for patient risk factors, according to the announcement.

Both medium- and high-intensity teaching hospitals had more readmissions for patients with myocardial infarction, congestive heart failure and pneumonia than nonteaching hospitals, although all the 2,418 hospitals studies performed well on quality measures.

High-intensity teaching hospitals that also were safety-net hospitals, with a patient mix weighted toward Medicaid patients with higher risk factors, had "persistently higher" readmission rates for the two heart conditions despite the lower mortality rates, the study found.

The study suggested teaching hospitals might not be adequately educating patients on discharge, leading to their return, or that patients with complex conditions who survive their initial hospitalization at a teaching hospital are more likely to require rehospitalization.

Another recent study found major teaching hospitals had significantly lower mortality rates than other hospitals, but higher complication rates and lower patient safety scores.

And a January research letter in the Journal of the American Medical Association found that large, academic and safety-net hospitals would receive the highest penalties for readmissions, with 44 percent of safety nets seeing steep cuts in reimbursements, compared with 30 percent of nonsafety-net hospitals.

For more:
- see the study abstract
- here's the announcement