Low-quality, high-cost hospitals care for more Medicaid and elderly minority patients in the Southern U.S.

High-cost hospitals that perform poorly on quality measures treat a significantly higher proportion of Medicaid and elderly minority patients, according to a study in Health Affairs.

For the study, researchers examined hospital cost, quality, and patient demographic data from six data sources for over 3,000 U.S. Hospitals.  Key findings from the study:

  • The “worst” hospitals (high-cost, low quality), care for double the proportion (15 percent versus 7 percent) of elderly black patients as the “best” hospitals (low-cost, high quality)
  • The “worst” hospitals care for 4% of elderly Hispanic patients, while the “best” hospitals care for 1%.
  • The “worst” hospitals care for 23% of elderly Hispanic patients, while the “best” care for 15%.
  • Patients with acute myocardial infarction at the “worst” hospitals were 7–10 percent more likely to die than those admitted to the "best" hospitals.
  • The “best” hospitals were more likely to be non-profit, academic medical centers in the Northeast, while the “worst” hospitals were more likely to be small, for profit hospitals in the South.
  • High-cost, high-quality hospitals had the best patient experiences, while low-cost, high-quality hospitals scored intermediately.

The authors conclude that in order quality to avoid financial penalties with value-based purchasing, and to avoid deepening disparities in care, poorly performing institutions will have to improve on both costs and quality.

(Sources: Health Affairs, http://content.healthaffairs.org, October, 2011; The Advisory Board Daily Briefing, The Advisory Board Daily Briefing, http://advisory.com, October 11, 2011)