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Does the Patient's Payer Matter in Hospital Patient Safety?: A Study of Urban Hospitals

Clement, Jan P. PhD*; Lindrooth, Richard C. PhD; Chukmaitov, Askar S. MD, PhD; Chen, Hsueh-Fen MS*

doi: 10.1097/01.mlr.0000244636.54588.2b
Original Article
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Background: Previous studies have documented that hospitals decrease costs in response to reimbursement cutbacks. However, research concerning how this may affect quality of care has produced mixed results. Until recently, the ability to study changes in patient safety and payment has been limited.

Objective: The objective of the study was to determine whether changes in 4 hospital patient safety indicator (PSI) rates are related to changes in the generosity of payers over time.

Data and Methods: Study data are drawn from 1995–2000 hospital discharges in 11 states in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Database. Following the same organizations over time, we estimate hospital fixed-effects regression models of the association of payer-specific time and post Balanced Budget Act (BBA) payment changes with risk-adjusted hospital PSI rates controlling for patient, organizational, and market characteristics. Four PSIs relevant to a large number of patients and hospitals that reflect general care processes are studied.

Results: The time trend during 1995–2000 is consistently significantly positive for private and Medicare hospital PSI rates. Thus, after controlling for patient characteristics and organizational and market factors, performance worsened. The trend is less consistent for Medicaid and does not exist for self-pay hospital PSI rates. After adjusting for multiple comparisons, we also find that the Medicare trend is fairly consistently higher than that of the other payers. In contrast, there is a less consistent BBA effect, especially for Medicare.

From the *Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia; the †Department of Health Administration and Policy, Medical University of South Carolina, Charleston, South Carolina; and the ‡Division of Health Affairs, Department of Family Medicine and Rural Health, College of Medicine, Florida State University, Tallahassee, Florida.

Supported by a grant from the Agency for Healthcare Research and Quality (grant #R01 HS13094).

Reprints: Jan P. Clement, PhD, Professor, Department of Health Administration, Virginia Commonwealth University, 1008 E. Clay Street, P.O. Box 980203, Richmond, VA 23298-0203. E-mail: jclement@vcu.edu.

© 2007 Lippincott Williams & Wilkins, Inc.