Are Hospitals Profiting by Shunning Patients of Color?
The pandemic has thrown into brutal relief the extent to which the U.S. health care system produces worse outcomes for patients of color. And yet there has been scant focus on one of the biggest drivers of structural racism in health care: How doctors and hospitals are paid. Despite waves of well-intentioned payment reforms in recent years, these programs have failed to prioritize the health of people of color, even making it worse in some cases. Programs that penalize hospitals for readmissions may unduly penalize institutions that care for sicker patients, who are often lower-income people of color. Value-based payment programs — which tie payments to quality and cost — can inadvertently lead doctors to avoid patients who are more likely to be dealing with higher rates of chronic illness and social and economic challenges that make it harder for them to achieve good health outcomes. Even when hospitals and providers are making rational decisions to boost their profits and quality scores, such patterns can have the unintended consequence of deepening health inequities and disparities in access to care— a prime example of structural racism. In this webinar, we’ll highlight the ways in which the health care system’s focus on money and good grades is shortchanging the health of communities of color. We’ll explore how good incentives can produce bad outcomes, and identify possible solutions. And we’ll give journalists tough questions to ask of health systems near them: Who is being overlooked in the eternal quest to boost profits?
This webinar is part of a mini-series exploring health equity in health systems in America. It is made possible by The Commonwealth Fund, the National Institute for Health Care Management Foundation, and The California Endowment.
Panelists
Amol Navathe, M.D., Ph.D. is an associate professor of health policy and medicine at the Perelman School of Medicine at the University of Pennsylvania, and a Commissioner of the Medicare Payment Advisory Commission (MedPAC), a non-partisan agency that advises Congress on Medicare policy. He has expertise in policy analysis and design, physician and hospital economic behavior, and application of informatics and predictive analytics to health care. Navathe is a leading scholar on payment model design and evaluation, particularly bundled payments. He founded a disciplinary academic journal, Health Care: The Journal of Delivery Science and Innovation, serving as its co-editor-in-chief, as well as founding director of the Foundation for Healthcare Innovation. His work on health care cost and quality improvement has been published in Science, New England Journal of Medicine, JAMA, Health Affairs, and other leading academic journals. He completed his medical training at the Perelman School of Medicine and his post-graduate medical training at the Brigham and Women’s Hospital at Harvard Medical School. He obtained his PhD in Health Care Management and Economics from The Wharton School.
Marshall Chin, M.D., MPH, the Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics at the University of Chicago, is a general internist and health services researcher with extensive experience caring for marginalized patients and advancing health equity. He co-directs the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation National Program Office, and co-chairs the Centers for Medicare and Medicaid Services Health Care Payment Learning and Action Network Health Equity Advisory Team. Dr. Chin was elected to the National Academy of Medicine in 2017 and is currently a member of its Council. Dr. Chin is a graduate of Harvard College and the University of California at San Francisco School of Medicine, and he completed residency and fellowship training in general internal medicine at Brigham and Women’s Hospital, Harvard Medical School.
View Dr. Amol Navathe's slides here.
View Dr. Marshall Chin's slides here.
Suggested reading
- “Why a Hospital Might Shun a Black Patient,” by Amol S. Navathe and Harald Schmidt, The New York Times
- “How to fix the two-tier U.S. health payment system,” by Amol Navathe, Risa Lavizzo-Mourey and Joshua Liao, First Opinion in STAT
- “Uncomfortable Truths — What Covid-19 Has Revealed about Chronic-Disease Care in America,” by Marshall Chin, M.D., MPH, The New England Journal of Medicine
- “Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program,” by Karen E. Joynt Maddox MD, MPH et al., Health Services Research (April 2019)
- “A National Goal to Advance Health Equity Through Value-Based Payment,” by Joshua M. Liao, Risa J. Lavizzo-Mourey and Amol S. Navathe, JAMA Network
- “Racial Profiling: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards,” by Rachel M. Werner, David A. Asch and Daniel Polsky, Circulation
- “Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?” by Jeffrey Clemens and Joshua D. Gottlieb, American Economic Review
- “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities,” by Laura C. Yasaitis, William Pajerowski, Daniel Polsky, and Rachel M. Werner, Health Affairs
- “Risk Adjustment In Medicare ACO Program Deters Coding Increases But May Lead ACOs To Drop High-Risk Beneficiaries,” by Adam A. Markovitz et al., Health Affairs
- “Communities in Action: Pathways to Health Equity,” National Academy of Medicine
- “Social Risk Factors and Medicare's Value-Based Purchasing Programs,” by the Office of the Assistant Secretary for Planning and Evaluation
- “Addressing Social Risk Factors In Value-Based Payment: Adjusting Payment Not Performance To Optimize Outcomes and Fairness,” by Jonathan B. Jaffery and Dana Gelb Safran, Health Affairs
- “REACHing” for Equity — Moving from Regressive toward Progressive Value-Based Payment,” by Suhas Gondi et al., The New England Journal of Medicine
- “Advancing Health Equity Through APMs,” via The Health Care Payment Learning & Action Network
- “A Call to Advance Equity in Health Care Payment” (online letter)