In Reply: Mr Aviles and Ms O’Connell take exception with our finding that hospitals with a higher percentage of Medicaid patients have lower baseline performance on average than other hospitals. We do not suggest that all safety-net hospitals have low performance, but that on average baseline hospital performance is lower if the percentage of patients insured by Medicaid is higher. This finding is consistent with numerous other studies that have found that a hospital's payer mix, its ownership (ie, public hospitals), and the race and socioeconomic status of its patients influence hospital performance1- 3 and suggests that safety-net hospitals face barriers to performing well on these measures.
Werner RM, Goldman LE, Dudley RA. Comparisons of Safety-Net and Non–Safety-Net Hospitals—Reply. JAMA. 2008;300(14):1650-1652. doi:10.1001/jama.300.14.1652