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If Our Worst Hospitals Don't Improve, Should We Let Them Fail?

October 7, 2011

According to a recent study by the Harvard School of Public Health, the "worst" hospitals in the US are more likely to treat the poorest patients than the best hospitals. Of course, this is not surprising. However, under the new Affordable Healthcare Act, these worst hospitals will soon have a choice: 1) improve; or 2) fail. This will happen because the new healthcare law punishes bad medical care by withholding a portion of their federal funding. In contrast, hospitals that improve their patient care, even those now considered among the worst, will be rewarded with an increase in federal funding. As a Chicago medical malpractice lawyer, I think forcing bad hospitals to either improve or fail is actually a good thing.

The Affordable Healthcare Act provides that any hospital that fails to improve patient care will see a one percent reduction in federal funding, beginning October 2011. According to Dr. Ashis Jha of the Harvad School of Public Health, some hospitals already on the brink of closure could fail under the new law. Says Dr. Jha, "I worry they're going to get worse over time and possibly even fail. I worry that we're going to see a bunch of that happening over the next three to five years." Dr. Jha believes an unintended consequence of the new law could be "increased health disparities for minorities."

It is true the new healthcare law may result in some unintended consequences to minorities. Some of the hospitals minorities routinely go to near their neighborhoods could fail (creating inconveniences associated with increased travel time to a better hospital). However, allowing these same hospitals to continue providing subpar medical care also has negative consequences. Minorities who regularly go to these worst hospitals are more likely to die or be seriously injured by medical malpractice. Continuing to allow these hospitals to receive the same funding, without demonstrating improvement, provides no incentive for them to improve their patient care. As a result, they will likely only continue committing an inordinate number of medical mistakes on minorities.

According to Medicare chief Don Berwick, the federal government's new laws are actually designed to help hospitals improve, including those that treat disadvantaged patients. In fact, "[t]here are examples of net hospitals that are some of the best in the country," says Berwick. A net hospital is a one that provides a significant level of care to low income, uninsured patients. Denver Health is one such net hospital that treats a high percentage of poor patients and, yet, has a low percentage of death rates.

For those hospitals that are in the "worst" category, they have at least one advantage; they start further behind and, therefore, have more opportunity to be rewarded by the government for improving their patient care. Indeed, the federal law also provides more money for hospitals that implement improvement programs. Thus, the new healthcare law provides a strong incentive for improvement. If these worst hospitals continue provide poor care--if they refuse to make any improvement--why shouldn't they fail?

Sources Used:

Associated Press Website, Study: Worst Hospitals Treat Larger Share Of Poor, October 5, 2011.

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