According to published results, the Medicare value-based purchasing program was not associated with improved patient experience or satisfaction at safety-net vs. non-safety-net hospitals.
Nicholas Chiu, MD, MPH, and colleagues performed a retrospective cohort study which evaluated 2,266 U.S. hospitals that participated in the Medicare value-based purchasing (VBP) program between 2008 and 2019. According to the study, 549 hospitals were deemed safety-net hospitals, defined as those in the highest quartile of the disproportionate share hospital index. The remaining hospitals were deemed non-safety-net hospitals.
The primary outcome measure was the Hospital Consumer Assessment of Healthcare Providers and Systems global measures of patient-reported experience and satisfaction, which includes overall patient experience, satisfaction and willingness to recommend the hospital.
Compared with non-safety-net hospitals, safety-net hospitals had lower patient experience scores across all measures from 2008 to 2019. Additionally, in both safety-net and non-safety-net hospitals, the percentage of patients who gave 9 or 10 out of 10 ratings or would recommend the hospital increased during the pre-VBP program, with a slower rate of increase after VBP program implementation. The researchers also noted no differential change in measures of communication, clinical process measures or discharge instructions under the VBP program in either hospital.
“These findings suggest that even over the long term, pay-for-performance initiatives may not meaningfully improve health care equity,” the researchers wrote in the study. “Policy makers may need to explore other strategies to improve patient-reported experience and satisfaction, including additional support for safety-net hospitals.”