How the Worst Hospitals in the U.S. Treat Patients

It was uncovered in a study that the worst hospitals in the U.S. treat twice the proportion of elderly black patients and poor patients than the best hospitals. The patients at these hospitals are more likely to die of pneumonia and heart attacks.

Under the Affordable Care Act, bad health care is being punished by withholding some money, putting these hospitals at finanical risk.

“These hospitals are going to have a much harder time in the new funding environment,” said Dr. Ashish Jha of the Harvard School of Public Health, who led the study. “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.”

Beginning in October 2012, hospitals whose performance didn't improve lost 1% of their Medicare payments.

There are 178 hospitals, most southern, that are rated as the “worst hospitals” because of their low quality of care and high costs. The hospitals cannot be named publicly. However 122 best hospitals were named. Those hospitals were more likely to be nonprofit, feature cardiac intensive care units, and be Northeastern.

How Can These Hospitals Improve Their Quality?

In the worst hospital list, elderly blacks made up 15 percent of patients. In the best hospitals, this demographic made up 7 percent.

“We know they can improve,” even if they treat sicker or disadvantaged patients, Medicare chief Don Berwick said. “There are examples of safety net hospitals that are some of the best in the country.” He cited Denver Health, which has low death rates despite treating a large share of poor patients.

“If I were talking to safety net hospitals, I would say, ‘I know it’s hard. Here’s some help, and if you start (improving), you’ll get rewarded for starting,’” Berwick said.

The researchers for the study used data from six sources to determine the hospitals that were the best and worst. The hospitals were divided into four ranked groups for cost.

There were 3,229 hospitals analyzed and 122 were in the top group for quality. Then researchers compared this group with the 178 that were in the bottom group for quality and had the highest costs.

“What can we do to take the lessons from the high-performing institutions and help the low performers improve?” Jha asked. In markets outside of health care, business closures don’t so directly affect people’s survival, he said, but “here, there are tens of thousands of lives at stake.”

The health law’s expansion of insurance in 2014 will allow patients to have more choice in hospitals. Generally speaking, people trust hospitals. Do you research the hospital before you go? Most people do not. For those who want to research the hospital, there is a government website you can go to that rates hospitals, called Hospital Commerce.

“People go to hospitals because they’ve always gone there or their families have always gone there or their doctors have always referred them there,” Jha said.

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