Address correspondence to Kevin Volpp, M.D., Ph.D., 1232 Blockley Hall, 423 Guardian Drive, Philadelphia, PA. Meena Seshamani, M.D., Ph.D. is with the Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. J. Sanford Schwartz, M.D., is with the Department of General Internal Medicine, University of Pennsylvania School of Medicine, Department of Health Care Systems, the Wharton School, Philadelphia, PA. Kevin G. Volpp, M.D., Ph.D., is with the Philadelphia Veterans Affairs Medical Center, Department of Health Care Systems, University of Pennsylvania School of Medicine, the Wharton School, Philadelphia.
The Effect of Cuts in Medicare Reimbursement on Hospital Mortality
Version of Record online: 25 JAN 2006
Health Services Research
Volume 41, Issue 3p1, pages 683–700, June 2006
How to Cite
Seshamani, M., Schwartz, J. S. and Volpp, K. G. (2006), The Effect of Cuts in Medicare Reimbursement on Hospital Mortality. Health Services Research, 41: 683–700. doi: 10.1111/j.1475-6773.2006.00507.x
- Issue online: 25 JAN 2006
- Version of Record online: 25 JAN 2006
- Balanced Budget Act;
- financial strain;
- quality of care
Objective. To determine if patients treated at hospitals under different levels of financial strain from the Balanced Budget Act (BBA) of 1997 had differential changes in 30-day mortality, and whether vulnerable patient populations such as the uninsured were disproportionately affected.
Data Source. Hospital discharge data from all general acute care hospitals in Pennsylvania from 1997 to 2001.
Study Design. A multivariate regression analysis was performed retrospectively on 30-day mortality rates, using hospital discharge data, hospital financial data, and death certificate information from Pennsylvania.
Data Collection. We used 370,017 hospital episodes with one of four conditions identified by the Agency for Healthcare Research and Quality as inpatient quality indicators were extracted.
Principal Findings. The average magnitude of Medicare payment reduction on overall net revenues was estimated at 1.8 percent for hospitals with low BBA impact and 3.6 percent for hospitals with a high impact in 1998, worsening to 2 and 4.8 percent, respectively, by 2001. Operating margins decreased significantly over the time period for all hospitals (p<.05). While unadjusted mortality rates demonstrated a disproportionate rise in mortality for patients from high impact hospitals from 1997 to 2000, adjusted analyses show no consistent, significant difference in the rate of change in mortality between high-impact and low-impact hospitals (p=.04–.94). Similarly, uninsured patients did not experience greater increases in mortality in high-impact hospitals relative to low-impact hospitals.
Conclusions. An analysis of hospitalizations in the Commonwealth of Pennsylvania did not find an adverse impact of increased financial strain from the BBA on patient mortality either among all patients or among the uninsured.