Comparison of 3 Safety-Net Hospital Definitions and Association With Hospital Characteristics

Abstract

Key Points Question Does a safety-net hospital definition based on uncompensated care identify different types of hospitals compared with other definitions? Findings In this cross-sectional study of 2066 hospitals, the Medicare Disproportionate Share Hospital index identified larger teaching safety-net hospitals, whereas a definition based on uncompensated care captured smaller, rural safety-net hospitals at greater financial risk. Bad debt and charity care were approximately twice as high for safety-net hospitals as for non–safety-net hospitals, unreimbursed costs were 38% higher, and operating margins were more than 6 times lower. Meaning Medicare Disproportionate Share Hospital payment formulas are evolving to emphasize uncompensated care, and hospitals may experience funding changes as a result.

Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study

“…The study was conducted at NYU Langone Health, which includes more than 260 outpatient office sites and four acute care hospitals (Tisch Hospital and NYU Langone Orthopedic Hospital in Manhattan, NYU Langone Hospital – Brooklyn in Brooklyn, and NYU Winthrop on Long Island), ranging from a quaternary care hospital to a safety net institution 17. As the epidemic evolved, the health system added intensive care unit (ICU) beds and inpatient capacity, resulting in a peak of about 394 ICU beds and 1357 non-ICU beds.…”

Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

“…Misclassification could adversely impact the financial viability of institutions with a larger share of uncompensated and unreimbursed care costs[1,23]. Such institutions would not be able to meet the healthcare needs of vulnerable populations[1].Our findings thus support the use of a revised definition based on uncompensated care for defining safety-net institutions[1].…”

“…The definition of safety-net institution may have considerable impact not only on health services reimbursement but also on understanding the healthcare needs of safety-net populations. Safety-net institutions are commonly defined according to the distribution of hospital-or health system-level characteristics such as the disproportionate share index, Medicare and uninsured caseload, and cost of uncompensated care [1]. Hospitals or health systems in the top quartile of each state based on these measures are considered safety-net institutions [1].…”

“…Safety-net institutions are commonly defined according to the distribution of hospital-or health system-level characteristics such as the disproportionate share index, Medicare and uninsured caseload, and cost of uncompensated care [1]. Hospitals or health systems in the top quartile of each state based on these measures are considered safety-net institutions [1]. Nevertheless, this approach may be problematic for several reasons [2].…”

Sociodemographic and Health-Related Characteristics of a Safety-Net Patient Population

“…Individuals who rely on safety-net institutions are often broadly described as underserved or medically vulnerable populations and include not only the uninsured but also underinsured, racial/ethnic minorities, unemployed, immigrants, chronically ill (physical or mental), disabled, veterans, homeless, or incarcerated [5]. Prior reports involving safety-net populations have largely been about specific conditions [8,9] or conducted at the hospital-level using aggregate definitions of patient characteristics [10][11][12][13][14]. Reports of specific conditions have limited generalizability to the broader safety-net population and hospital-level (i.e.…”