Refining the Definition of US Safety-Net Hospitals to Improve Population Health

Tyler N A Winkelman,Katherine Diaz Vickery

doi:10.1001/jamanetworkopen.2019.8562

Tyler N A Winkelman, Katherine Diaz Vickery

Open Access

https://doi.org/10.1001/jamanetworkopen.2019.8562

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Journal: JAMA Network Open	Publication Date: Aug 7, 2019
Citations: 6	License type: cc-by

Affiliation: Hennepin Healthcare Research Institute

Abstract

Safety-net hospitals (SNHs) in the United States provide care for individuals and families regardless of their ability to pay.1 Since 1986, SNHs have received supplemental federal compensation through Medicare Disproportionate Share Hospital (DSH) payments. These payments have historically been calculated based on the proportion of hospital days accounted for by Medicare Supplemental Security Income plus Medicaid, non-Medicare inpatient days. The Affordable Care Act (ACA) modified this definition and reduced DSH payments to offset a growing insured, low-income population.2

Highlights

In JAMA Network Open, Popescu et al[3] highlight the implications of modifying the definition of SNHs used by the Centers for Medicare & Medicaid Services to allocate Disproportionate Share Hospital (DSH) payments
Hospitals classified as SNHs under the traditional DSH formula were more likely to be larger, urban teaching hospitals
Hospitals under the latter definitions were less financially stable, had larger unreimbursed costs from public payers, and incurred larger amounts of bad debt compared with SNHs under the traditional DSH formula

Summary

SNH Definitions Matter

In JAMA Network Open, Popescu et al[3] highlight the implications of modifying the definition of SNHs used by the Centers for Medicare & Medicaid Services to allocate DSH payments. The authors examined concordance among SNH definitions based on the traditional Medicare DSH index and 2 commonly used contrasting definitions of safety-net status, the proportion of inpatient stays that were uninsured or paid by Medicaid and the cost of uncompensated care They defined SNHs as those in the top quartile of each definition and found that each definition isolated a unique group of hospitals with limited overlap. SNH hospitals defined by Medicaid and uninsured caseload or uncompensated care were smaller and more rural and offered fewer services Hospitals under the latter definitions were less financially stable, had larger unreimbursed costs from public payers, and incurred larger amounts of bad debt compared with SNHs under the traditional DSH formula

Align DSH Payments With National Health Priorities

Future Directions

Conclusions