Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings

Belasen, Ariel R; Tracey, Marlon R; Belasen, Alan T

OBJECTIVE: To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. DESIGN: A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. A multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. SETTING: Hospital ratings are measured by Hospital Compare using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for hospitals in the USA. PARTICIPANTS: 2,816 Medicare-certified acute care hospitals across all US states. INTERVENTION: None. MAIN OUTCOME MEASURE: Differences in the marginal impacts of key community demographics on patient experiences between the two groups of hospitals. RESULTS: We provide evidence that low-rated hospitals have much more variability in patient experience ratings than high-rated ones. Moreover, the experiences at low-rated hospitals are more sensitive to county demographic factors, which means exogenous shocks, like coronavirus disease-2019 (COVID-19), will likely affect these hospitals differently, as such shocks are known to disproportionately affect their communities. CONCLUSIONS: Our results imply that low-rated hospitals with more variability in their HCAHPS responses are more likely to face adverse patient experiences due to COVID-19 than high-rated hospitals. Pandemics like COVID-19 create conditions that intensify the already high demands placed on hospitals and care providers and make it even more challenging to deliver quality care.