Obamacare Hurting Hospitals, Doctors Treating Poorest Patients

Monday, 28 Apr 2014 08:42 AM

By Melanie Batley

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An Obamacare policy designed to reward healthcare providers based on the quality of their performance is penalizing doctors and hospitals that treat large numbers of poor people, a new report has found.

Medicare and private insurers are increasingly paying healthcare providers based on the quality of the care they provide, but a study by the National Quality Forum found the system is flawed because it does not take into account that it is often more difficult to achieve success for those with low incomes or less education, The New York Times reported.

"Factors far outside the control of a doctor or hospital — patients' income, housing, education, even race — can significantly affect patient health, healthcare, and providers' performance scores," Dr. Christine Cassel, president of the nonprofit group, told the Times.

According to the study by a 26-member panel of experts and commissioned by the Obama administration, low-income people may be unable to afford prescribed medications or transportation for follow-up appointments, for example, while those with lower levels of education are more likely to have difficulty understanding or following instructions for home care and the use of medications.

The payment policies therefore shift money away from doctors and hospitals that care for disadvantaged patients, according to the Times.

"The administration's current policy on adjustments for socioeconomic status are quite inadvertently exacerbating disparities in access to medical care for poor people who live in isolated neighborhoods. I'm sure that's not what President Obama intended with the Affordable Care Act," Steven Lipstein, president of BJC HealthCare in St. Louis and a member of the panel, told the Times.

Administration officials acknowledged they are dismayed by the findings and say that despite the report's conclusions, performance scores should not be adjusted to reflect differences in the income, race, or socioeconomic status of patients, the Times reported.

"We do not want to hold hospitals to different standards of care simply because they treat a large number of low-socioeconomic-status patients," Dr. Kate Goodrich, director of quality measurement programs at the Centers for Medicare and Medicaid Services, told the Times.

"Our position has always been not to risk-adjust for socioeconomic status within our measures because of concern about masking disparities, and potentially rewarding providers who provide a lower level of care for minorities or poor patients."

Meanwhile, another federal healthcare mandate which requires doctors to install expensive, complex software systems, is also taking a toll on doctors who say they are losing money both because of the cost of the equipment and because working with the software is so time-consuming they have less time to see patients, The San Diego Union-Tribune reported.

"The medical world is going IT, and this will be very hard for small physician practices," Harvard health economist David Cutler told the Union-Tribune. "Just as small retail stores had to find a niche they could fit in with bigger, IT-enabled competitors, so too will small M.D. practices. Undoubtedly, many will not survive."

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