The Effect of Financial Incentives on Hospitals That Serve Poor Patients
Authors: Ashish K. Jha, Arnold Epstein, E. John Orav
Journal: Annals of Internal Medicine (2011)

Letters1 March 2011The Effect of Financial Incentives on Hospitals That Serve Poor PatientsAshish K. Jha, MD, MPH, Arnold Epstein, MD, MA, and E. John Orav, PhDAshish K. Jha, MD, MPHFrom Harvard School of Public Health, Boston, MA 02115, and Brigham and Women's Hospital, Boston, MA 02120-1613.Search for more papers by this author, Arnold Epstein, MD, MAFrom Harvard School of Public Health, Boston, MA 02115, and Brigham and Women's Hospital, Boston, MA 02120-1613.Search for more papers by this author, and E. John Orav, PhDFrom Harvard School of Public Health, Boston, MA 02115, and Brigham and Women's Hospital, Boston, MA 02120-1613.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-5-201103010-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Mansi highlights 2 important issues that we agree warrant discussion. The first issue is the inadequacy of available data on the proportion of poor patients cared for in any specific hospital. We used the disproportionate-share index, which is a composite of the proportion of elderly Medicare patients who are poor (defined as receiving Supplemental Security Income) and the proportion of patients who are not elderly and have Medicaid insurance (1).Dr. Mansi is correct that the disproportionate-share index excludes uninsured patients. Thus, if a hospital had a high proportion of uninsured patients but also had very few ...References1. Centers for Medicare & Medicaid Services. Disproportionate share hospital (DSH). Accessed at www.cms.gov/AcuteInpatientPPS/05_dsh.asp#TopOfPage on 20 October 2010. Google Scholar2. Jha AK, Orav EJ, Li Z, Epstein AM. The inverse relationship between mortality rates and performance in the Hospital Quality Alliance measures. Health Aff (Millwood). 2007;26:1104-10. [PMID: 17630453] CrossrefMedlineGoogle Scholar3. Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293:1239-44. [PMID: 15755946] CrossrefMedlineGoogle Scholar4. Werner RM, Bradlow ET. Public reporting on hospital process improvements is linked to better patient outcomes. Health Aff (Millwood). 2010;29:1319-24. [PMID: 20606180] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard School of Public Health, Boston, MA 02115, and Brigham and Women's Hospital, Boston, MA 02120-1613.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0442. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effect of Financial Incentives on Hospitals That Serve Poor Patients Ashish K. Jha , E. John Orav , and Arnold M. Epstein The Effect of Financial Incentives on Hospitals That Serve Poor Patients Ishak A. Mansi Metrics Cited ByImpact of Provider Incentives on Quality and Value of Health Care 1 March 2011Volume 154, Issue 5Page: 370-371KeywordsConflicts of interestDisclosureElderlyHealth careHealth care qualityMedicareMotivationPatients ePublished: 1 March 2011 Issue Published: 1 March 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...