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Value-based payments disproportionately impact safety net hospitals

Value-based incentive programs aimed at reducing health care-associated infections did not improve infection rates in either safety net or non-safety net hospitals, found a study by researchers at Boston Medical Center in collaboration with Harvard Pilgrim Health Care Institute.

Published in JAMA Network Open , the results also demonstrate persistent disparities in infection rates between the two hospital types, with higher rates of healthcare-associated infections in safety net hospitals.


In 2001, safety net hospitals were defined by the Institute of Medicine as hospitals that provide care to a large share of uninsured or Medicaid patients, regardless of their ability to pay. As a result, many safety-net hospitals are under more financial stress than non-safety-net hospitals and rely on supplemental funding from both the state and the federal government to remain operational.

According to America’s Essential Hospitals, the average operating margin for its national membership of safety net hospitals was 1.6% in 2017; for all hospitals nationwide, that rate was 7.8%.

Reducing healthcare-associated infections is a main target of quality improvement efforts across all health systems. The Affordable Care Act established two value-based incentive programs to target healthcare-associated infections that were put in place in 2014: the Hospital Value-Based Purchasing […]

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