Safety net hospital

Last updated

A safety net hospital is a type of medical center in the United States that by legal obligation or mission provides healthcare for individuals regardless of their insurance status (the United States does not have a policy of universal health care) or ability to pay. [1] [2] [3] This legal mandate forces safety net hospitals (SNHs) to serve all populations. Such hospitals typically serve a proportionately higher number of uninsured, Medicaid, Medicare, Children's Health Insurance Program (CHiP), low-income, and other vulnerable individuals than their "non-safety net hospital" counterpart. [1] [2] [3] Safety net hospitals are not defined by their ownership terms; they can be either publicly or privately owned. [3] [2] The mission of safety net hospitals is rather to provide the best possible care for those who are barred from health care due to the various possible adverse circumstances. These circumstances mostly revolve around problems with financial payments, insurance plans, or health conditions. [3] [1] Safety net hospitals are known for maintaining an open-door policy for their services. [4]

Contents

Some safety net hospitals even offer high-cost services like burn care, trauma care, neonatal treatments, and inpatient behavioral health. Some also provide training for healthcare professionals. The Health and Hospital Corporation in NYC, Cook County Health and Hospital System in Chicago, and Parkland Health & Hospital System in Dallas are three of the United States' largest safety net hospitals. [5]

History

The presence of philanthropic medical institutions during the 19th century pre-date the modern American safety net hospital. These hospitals were funded by religious groups or wealthy benefactors, and their target population was the poor. [6] However, towards the turn of the century, these institutions began transitioning into for-profit organizations, as they began to accept patients from all socioeconomic backgrounds. Towards 1922, as these businesses grew, revenue from patient care accounted for 65.2% of the total revenue for these community hospitals. Along with the introduction of private insurance, Medicare, and Medicaid during the 1980s, [7] by the time 1994 arrived, 94% of the revenue came from patient care. [6] However, in 1996, approximately 43 million people (one-fifth of the U.S. population under age 65) had no medical insurance and an additional 29 million were underinsured. These numbers were also expected to rise in the next decade. [7] This led to the advent of what we consider a safety net hospital. Hospitals were already practicing uncompensated health care during the 1980s, with the help of state funding and Disproportionate Share Hospital (DSH) programs, in order to provide medical treatment to the uninsured and the underinsured in urban cities. However, this practice became more commonplace when the state of health care began to look difficult.

Financing a safety net hospital

Safety net hospitals oftentimes find themselves in difficult financial positions due to the vulnerable financial state of the patients and lack of sufficient federal, state and local funding; safety net hospitals have high rates of Medicaid and Medicare payers [8] [9] [1] (Medicaid has unreliable/insufficient processes of government to hospital repayment [8] ) and a large proportion of safety net hospital patients serve traditionally low income and marginalized/vulnerable populations. [8] [10] [1] There is a complex array of public funding that comes to safety net hospitals (as being legally defined as a safety net hospital entitles these entities to financial compensation to overcome the cost of medical expenses not paid for by patients) mostly through Medicaid Disproportionate Share Hospital Payments, Medicaid Upper Payment Limit Payments, Medicaid Indirect Medical Education Payments, and state/local indigent health programs. [8] [11] However, these financial entities created to sustain safety net hospitals in repayments are often not enough. According to the National Rural Health Association, 83 rural hospitals have closed since 2010 due to the substantial financial pressure. [12] In 2013, hospitals across the United States generated $44.6 billion in uncompensated care costs; uncompensated care costs are costs accrued from services that the hospitals provided to patients that were not able to pay and that also went unpaid by government entities. [11] Additionally, there tends to be a lack of socioeconomic development and a lack of health care providers (both general and specialized) in the geographical regions where safety net hospitals tend to be located; this observation is made by Waitzkin and he refers to these facts as part of the social and structural "contradictions" that safety net hospitals face further negatively impact there financial stability and care performance. [3] Besides, many of the level I trauma centers are within safety net hospitals and their financial stability is highly affected by policy changes. [13] In a study, they found that county SNHs were the last in net revenue income compared to non-profit SNHs and non-SNHs ($41.6 million vs $111.4 million vs $287.1 million, respectively). [13] Although ACA has changed the financial situation of SNHs, county SNHs still faced a negative margins in 2015. However, for many hospital types, the net patient revenue increased. [13]

Prospects for safety net hospitals under the Patient Protection and Affordable Care Act

Under statute, Medicaid and Medicare issue disproportionate share hospital (DSH) payments that offset hospitals’ expenditures for uncompensated care. These payments are intended to improve access for Medicaid recipients and uninsured patients, as well as to shore up the financial stability of safety-net hospitals. Prior to the Patient Protection and Affordable Care Act (ACA, also known as "Obamacare"), the Medicare portion of the program has already been limited, and under the ACA the Medicaid portion of the program is also scheduled to be restricted. [14] This was built into the law under the assumption that the amount of uncompensated care would decline substantially under the ACA due to expanded coverage. [14] However, coverage did not expand as much as anticipated in many states due to the unanticipated choice not to expand Medicaid access under the Act (a result of National Federation of Independent Business v. Sebelius ). [14] An additional issue with Obamacare and safety net hospitals arises from the coverage gap for those who have too high of an income to qualify for Medicaid but have too low of an income to afford a private plan; it is projected that even with the implementation of the health care law in 2016, roughly 30 million people are still expected to be without insurance coverage [15] [16] and find service in safety net hospitals. Another issue revolves around the fact that hospitals are required to provide care for patients in the emergency department, even if the person cannot pay or is an illegal immigrant. [9]

Safety net hospitals under the Trump Administration

The American Health Care Act of 2017 (AHCA), if passed, would have repealed part of the Patient Protection and Affordable Care Act in such that it would have cut Medicaid coverage for lower-income Americans and effectively stopped ACA's Medicaid expansion, which was projected to result in loss of coverage for 24 million people by 2026. [17] [18] In addition, it would have placed a limit on federal funding that states could receive to cover health insurance to millions of low-income patients. [19] These federal cuts and increased enrollment criteria for federal welfare programs were projected to create an inevitable cost shift on patients and make it more difficult for Americans to be able to participate and receive aid from federal programs. Less money allocated to federal programs and the simultaneous repeals to Obamacare was expected to lead to less patients receiving financial help and qualifying for insurance programs, meaning that they would have had to pay more out of pocket for any services received. It was estimated that there would be 15 million [20] fewer individuals insured with "Trumpcare" than with Obamacare. [19] [21] This was expected to directly impact safety net hospitals because of increases in the number of patients without insurance and decreased financial support from the federal government. [21] [22] The aforementioned proposed act was criticized for its potential to increase financial burdens and operational constraints on both patients and safety net hospitals. It was predicted that under the AHCA, hospitals in both expanded Medicaid and nonexpanded states would have negative operating margins by 2026, endangering the quality of patient care for low-income communities, and ultimately, threatening hospital closures. [23] The act failed to pass in the United States Senate.

Types of safety net providers

Federally Qualified Health Centers (FQHCs)

Federally Qualified Health Centers are public and private non-profit health care organizations that meet federally mandated requirements to provide comprehensive and appropriate health care services to medically underserved populations. They must also adjust service fees to patient capacity to pay, have an ongoing qualify assurance program, and have a governing board of directors. [24] In turn, FQHCs receive reimbursements from Medicaid through their Prospective Payment System (PPS). They can also apply for the Health Center Program grant from the U.S. Department of Health and Human Resources and Services Administration. [25]

Federally Qualified Health Center Look-Alikes (FQHC look-alikes)

FQHCs that meet all the federal health center program requirements but don't receive health center grant funding are called FQHC look-alikes. These FQHCs are typically non-profit community health centers and regional clinical associations.

Rural Health Centers (RHC)

Rural Health Centers are public, private, or non-profit health centers that provide primary care to Medicaid and Medicare populations in rural areas. RHC status is designated by the Centers for Medicare and Medicaid Services, providing enhanced reimbursements rates for services. A health center cannot be both an RHC and a FQHC.

Disproportionate Share Hospitals (DSH)

Disproportionate share hospital are characterized by a significantly high number of low-income patients that is disproportionate. These hospitals do not receive payment for their services and are not reimbursement by Medicare, Medical, health insurance, or the Children's Health Insurance Program. State submit independent certified audits along with an annual report detailing how their payments to each DSH Hospital. After doing so they states receive Federal Financial Participation (FFP), an annual allotment. [26]

Community Health Centers

Community Health Centers are clinics with a mission to provide care to low-income populations regardless of their ability to pay. However, they do not have to meet any federal requirements because they do not receive federal funding or reimbursements from medicare or medical. They usually operate through donations. [24]

List of safety net hospitals in the United States [27]

Alabama [28]

Arizona

Arkansas

California

The 21 hospitals part of California's health care safety net system is represented by the California Association of Public Hospitals and Health Systems. These 21 hospitals are 6% of all the hospitals in California but provide care for 80% of the state's population. 40% of their total hospital services is for uninsured patients and 35% is for Medicaid Patients. [29]

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Jersey

New Mexico

New York

North Carolina

Ohio

Oregon

Pennsylvania

Rhode Island

South Carolina

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Patient experience in safety net hospitals

Studies have shown that safety net hospitals, when compared to non-safety net hospitals (and other healthcare institutions [2] ), do not perform as well in overall patient care and patient experience ratings. [30] [10] In response to these critiques, some safety net hospitals have begun to offer customer service trainings, conduct employee evaluations and advocate for policy changes that could improve the patient experience. [31] Hospitals are trying to increase their compassion and quality of care in order to satisfy patient experiences. [32] Patients with a satisfying care experience are more likely to recommend hospitals to others. [32]

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act.

In the United States, charity care is health care provided for free or at reduced prices to low income patients. The percentage of doctors providing charity care dropped from 76% in 1996–97 to 68% in 2004–2005. Potential reasons for the decline include changes in physician practice patterns and increasing financial pressures. In 2006, Senate investigators found that many hospitals did not inform patients that charity care was available. Some for-profit hospitals provided as much charity care as some non-profit hospitals. Investigators also found non-profit hospitals charging poor, uninsured patients more than they did patients with health insurance. Hospitals must provide some charity care if they wish to maintain non-profit status.

<span class="mw-page-title-main">Free clinic</span> Non-profit health care clinics in the US

A free clinic or walk in clinic is a health care facility in the United States offering services to economically disadvantaged individuals for free or at a nominal cost. The need for such a clinic arises in societies where there is no universal healthcare, and therefore a social safety net has arisen in its place. Core staff members may hold full-time paid positions, however, most of the staff a patient will encounter are volunteers drawn from the local medical community.

Health care prices in the United States of America describe market and non-market factors that determine pricing, along with possible causes as to why prices are higher than in other countries.

A public hospital, or government hospital, is a hospital which is government owned and is fully funded by the government and operates solely off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care free of charge to patients, covering expenses and wages by government reimbursement.

<span class="mw-page-title-main">Massachusetts health care reform</span> 2006 healthcare reform law in Massachusetts

The Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.

The United States government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) programs, under which facilities are able to receive at least partial compensation.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

<span class="mw-page-title-main">Health insurance coverage in the United States</span>

In the United States, health insurance coverage is provided by several public and private sources. During 2019, the U.S. population overall was approximately 330 million, with 59 million people 65 years of age and over covered by the federal Medicare program. The 273 million non-institutionalized persons under age 65 either obtained their coverage from employer-based or non-employer based sources, or were uninsured. During the year 2019, 89% of the non-institutionalized population had health insurance coverage. Separately, approximately 12 million military personnel received coverage through the Veteran's Administration and Military Health System.

<span class="mw-page-title-main">Affordable Care Act</span> U.S. federal statute also known as Obamacare

The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act's provisions are still in effect.

<span class="mw-page-title-main">Healthcare in the United States</span>

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.

The community health center (CHC) in the United States is the dominant model for providing integrated primary care and public health services for the low-income and uninsured, and represents one use of federal grant funding as part of the country's health care safety net. The health care safety net can be defined as a group of health centers, hospitals, and providers willing to provide services to the nation's uninsured and underserved population, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. According to the U.S. Census Bureau, 29 million people in the country were uninsured in 2015. Many more Americans lack adequate coverage or access to health care. These groups are sometimes called "underinsured". CHCs represent one method of accessing or receiving health and medical care for both underinsured and uninsured communities.

An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".

A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.

Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.

The 340B Drug Pricing Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to "stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services." Maintaining services and lowering medication costs for patients is consistent with the purpose of the program, which is named for the section authorizing it in the Public Health Service Act (PHSA) It was enacted by Congress as part of a larger bill signed into law by President George H. W. Bush.

<span class="mw-page-title-main">America's Essential Hospitals</span>

America's Essential Hospitals is an industry trade group that represents more than 300 hospitals that fill a safety net role in their communities. The association, a nonprofit organization based in Washington, DC, was formed in 1981 as the National Association of Public Hospitals.

<span class="mw-page-title-main">Medical deserts in the United States</span> Areas with limited access to healthcare in the United States

The United States has many regions which have been described as medical deserts, with those locations featuring inadequate access to one or more kinds of medical services. An estimated thirty million Americans, many in rural regions of the country, live at least a sixty-minute drive from a hospital with trauma care services. Regions with higher rates of Medicaid and Medicare patients, as well those who lack any health insurance coverage, are less likely to live within an hour of a hospital emergency room. Although concentrated in rural regions, health care deserts also exist in urban and suburban areas, particularly in predominantly Black communities in Chicago, Los Angeles and New York City. Racial demographic disparities in healthcare access are also present in rural areas, particularly in Native American communities which experience worse health outcomes and barriers to accessing quality medical care. Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes.

References

  1. 1 2 3 4 5 Becker, Gay (2004). "Deadly Inequality in the Health Care 'Safety Net': Uninsured Ethnic Minorities' Struggle to Live with Life-Threatening Illnesses". Medical Anthropology Quarterly. 18 (2): 258–275. doi:10.1525/maq.2004.18.2.258. JSTOR   3655479. PMID   15272807.
  2. 1 2 3 4 Anderson, Ron; Cunningham, Peter; Hofmann, Paul; Lerner, Wayne; Seitz, Kevin; McPherson, Bruce (2009). "Protecting the Hospital Safety Net". Inquiry. 46 (1): 7–16. doi: 10.5034/inquiryjrnl_46.01.7 . JSTOR   29773398. PMID   19489480.
  3. 1 2 3 4 5 Waitzkin, Howard (24 May 2005). "Commentary-The History and Contradictions of the Health Care Safety Net: History and Contradictions of the Health Care Safety Net". Health Services Research. 40 (3): 941–952. doi:10.1111/j.1475-6773.2005.00430.x. PMC   1361178 . PMID   15960699.
  4. ↑ America's Health Care Safety Net. 2000. doi:10.17226/9612. ISBN   978-0-309-06497-2. PMID   25077222. NBK224523.[ page needed ]
  5. ↑ Zaman, Obaid; Cummings, Linda; Laycox, Sandy. "AMERICA'S SAFETY NET HOSPITALS AND HEALTH SYSTEMS" (PDF). National Public Health and Hospital Institute.
  6. 1 2 Fishman, Linda E.; Bentley, James D. (July 1997). "The Evolution of Support for Safety-Net Hospitals". Health Affairs. 16 (4): 30–47. doi: 10.1377/hlthaff.16.4.30 . PMID   9248148.
  7. 1 2 "The Dependence of Safety Net Hospitals and Health Systems on the Medicare and Medicaid Disproportionate Share Hospital Payment Programs". Commonwealth Fund. October 1999. Retrieved 2018-11-02.
  8. 1 2 3 4 Fagnani, Lynne (Nov 1999). "The Dependence of safety net Hospitals and Health Systems On the Medicare and Medicaid disproportionate Share Hospital Payment Programs" (PDF).
  9. 1 2 W., Burt, Catharine; E., Arispe, Irma (October 18, 2017). "Characteristics of emergency departments serving high volumes of safety-net patients; United States, 2000". Vital and Health Statistics. Series 13, Data from the National Health Survey (155): 1–16. PMID   15181760.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. 1 2 Werner, Rachel M. (14 May 2008). "Comparison of Change in Quality of Care Between Safety-Net and Non–Safety-Net Hospitals". JAMA. 299 (18): 2180–2187. doi: 10.1001/jama.299.18.2180 . PMID   18477785.
  11. 1 2 Gaskin, Darrell J.; Hadley, Jack (September 1999). "Population characteristics of markets of safety-net and non-safety-net hospitals". Journal of Urban Health. 76 (3): 351–370. doi:10.1007/BF02345673. PMC   3456829 . PMID   12607901.
  12. ↑ "'Safety Net' Hospitals". www.pewtrusts.org. Retrieved 2018-11-01.
  13. 1 2 3 Knowlton, LM; Morris, AM; Tennakoon, L; Spain, DA; Staudenmayer, KL (August 2018). "Financial Stability of Level I Trauma Centers Within Safety-Net Hospitals". Journal of the American College of Surgeons. 227 (2): 172–180. doi: 10.1016/j.jamcollsurg.2018.03.043 . PMID   29680414.
  14. 1 2 3 Rudowitz, Robin (18 November 2013). "How Do Medicaid Disproportionate Share Hospital (DSH) Payments Change Under the ACA?" (PDF). Kaiser Family Foundation . Retrieved 9 April 2018.
  15. ↑ Sommers, Benjamin D. (17 December 2015). "Health Care Reform's Unfinished Work — Remaining Barriers to Coverage and Access". New England Journal of Medicine. 373 (25): 2395–2397. doi:10.1056/nejmp1509462. PMID   26509829. S2CID   205111956.
  16. ↑ Oberlander, Jonathan (6 December 2012). "The Future of Obamacare". New England Journal of Medicine. 367 (23): 2165–2167. doi:10.1056/nejmp1213674. PMID   23171062.
  17. ↑ Kaplan, Thomas (2017-03-13). "Health Bill Would Add 24 Million Uninsured but Save $337 Billion, Report Says". New York Times. Retrieved October 25, 2018.
  18. ↑ Dobson, Allen (2017). "The Financial Impact of the American Health Care Act's Medicaid Provisions on Safety-Net Hospitals". Common Wealth Fund. doi:10.26099/8q8y-8841 . Retrieved October 25, 2018.
  19. 1 2 "H.R. 1628, Better Care Reconciliation Act of 2017". Congressional Budget Office. 2017-06-26. Retrieved 2017-11-09.
  20. ↑ McCarthy, Michael (18 January 2017). "Obamacare repeal could leave 32 million uninsured and double premiums, report finds". BMJ. 356: j310. doi:10.1136/bmj.j310. PMID   28100455. S2CID   40887144. ProQuest   1859752365.
  21. 1 2 Oberlander, Jonathan (5 January 2017). "The End of Obamacare". New England Journal of Medicine. 376 (1): 1–3. doi:10.1056/nejmp1614438. PMID   27959711.
  22. ↑ Bazzoli, Gloria J.; Lindrooth, Richard C.; Kang, Ray; Hasnain-Wynia, Romana (23 March 2006). "The Influence of Health Policy and Market Factors on the Hospital Safety Net". Health Services Research. 41 (4 Pt 1): 060720074824054––. doi:10.1111/j.1475-6773.2006.00528.x. PMC   1797078 . PMID   16899001.
  23. ↑ Haught, Randy; Dobson, Allen; DaVanzo, Joan; Abrams, Melinda K. (2017). "How the American Health Care Act's Changes to Medicaid Will Affect Hospital Finances in Every State". Commonwealth Fund. doi:10.26099/g6yx-hm69.{{cite journal}}: Cite journal requires |journal= (help)
  24. 1 2 "The Healthcare Safety Net: Types of Providers". Association of State and Territorial Health Officials.
  25. ↑ "FQHC Issues - California Association of Public Hospitals and Health Systems". California Association of Public Hospitals and Health Systems. Retrieved 2018-11-01.
  26. ↑ "Medicaid Disproportionate Share Hospital (DSH) Payments". Centers for Medicare & Medicaid Services.
  27. ↑ "Our Members by State - America's Essential Hospitals". America's Essential Hospitals. Retrieved 2018-11-01.
  28. ↑ Ranaivo, Yann (October 22, 2013). "Report: Birmingham has weak safety net for uninsured". www.bizjournals.com. Retrieved 2019-07-08.
  29. ↑ "Facts and Figures". California Association of Public Hospitals and Health Systems.
  30. ↑ Chatterjee, Paula; Joynt, Karen E.; Orav, E. John; Jha, Ashish K. (10 September 2012). "Patient Experience in Safety-Net Hospitals: Implications for Improving Care and Value-Based Purchasing". Archives of Internal Medicine. 172 (16): 1204–1210. doi: 10.1001/archinternmed.2012.3158 . PMID   22801941.
  31. ↑ Goldman, L. Elizabeth; Henderson, Stuart; Dohan, Daniel P.; Talavera, Jason A.; Dudley, R. Adams (May 2007). "Public Reporting and Pay-for-Performance: Safety-Net Hospital Executives' Concerns and Policy Suggestions". Inquiry. 44 (2): 137–145. doi:10.5034/inquiryjrnl_44.2.137. PMID   17850040. S2CID   33262954.
  32. 1 2 Clark, C. "HOW SAFETY-NET HOSPITALS ARE IMPROVING THE PATIENT EXPERIENCE". health leaders media.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.