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Research Highlight: Federal Incentive Programs May Worsen Health Care Disparities

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New federal incentive programs designed to improve the quality of hospital care may actually worsen disparities for patients at facilities that serve large numbers of socioeconomically disadvantaged people, according to a new analysis by a Weill Cornell Medical College researcher.

Hospitals with especially high numbers of these patients received lower adjustments in Medicare payments tied to healthcare performance measures than did institutions with smaller populations of disadvantaged patients, reports Dr. Andrew Ryan, associate professor of public health in the Division of Outcomes and Effectiveness Research. Dr. Ryan's results, based on 2012 data from the Hospital Value-Based Purchasing Program, were published Dec. 25 in the New England Journal of Medicine.

Though the program's incentives are linked to adherence with evidence-based medicine and patient experience, those criteria will gradually emphasize outcome performance, such as 30-day mortality, "which may further hurt hospitals that care for more disadvantaged payments," Dr. Ryan writes in the commentary.

He proposes solutions to the problem such as providing greater weight to improvement than achievement, considering hospitals' performances as they compare to those of facilities with similar patient populations, and increasing technical assistance to hospitals with high numbers of disadvantaged patients.  

"Programs that tie financial incentives to quality and efficiency have the potential to push our health care system to reward value rather than volume," Dr. Ryan writes. "However, a redistribution of resources away from hospitals serving high numbers of disadvantaged patients could worsen disparities in care."

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