In Reply We thank Dr Doherty for his interest in our study and for his important comments. Scoring systems that bin patients into 4 or 5 groups based on severity of illness or socioeconomic status do not adequately capture the complexity of many patients, especially those at safety-net hospitals. Also, as we acknowledged in a previous study,1 safety-net hospitals must maintain a broad array of less profitable services to meet the needs of their patient population, which adds to their overhead costs. We also agree that diverting these patients away from safety-net hospitals will likely only redistribute the cost burden to other hospitals.
Hoehn RS, Go DE, Shah SA. Safety-Net Hospitals Care—Reply. JAMA Surg. 2016;151(12):1192-1193. doi:10.1001/jamasurg.2016.3647