Hold up. Before everybody gets excited about rewarding good hospitals and punishing the bad ones, it’s worth pondering why a hospital might look worse than it is.

As is the case with education, those serving poorer populations often face problems that those serving the affluent don’t.

Read: Are health care providers setting costs based on patient coverage?

A new report suggests that hospitals in low-income areas may be unfairly hit by reimbursement models that pay hospitals with low readmission rates more than those whose patients end up back in the hospital more frequently.

Medicare has already put in place that type of reimbursement system for patients recovering from certain types of surgeries and some states have put similar policies in place for their Medicaid programs.

Gretchen Cutler, a researcher at Children's Hospitals and Clinics of Minnesota and co-author of the study, told Minnesota Public Radio that poorer patients often find themselves back in a hospital bed because they were not able to take care of themselves in the way prescribed at their last hospital visit.

They have a harder time obtaining the medicine they may need and are less likely to get to necessary follow-up appointments because of transportation barriers.

Read: These 10 hospitals could pick your pocket clean

"As long as we know these factors make a difference in readmissions, it's not fair to penalize hospitals specifically for the patients they serve," Cutler told the radio station.

The vision of outcome-based payment models, long considered an elusive goal of reform advocates, got a big boost on Tuesday when the Centers for Medicare and Medicaid Services announced it had come to an agreement with America’s Health Insurance Plans, the insurance trade group, on a set of metrics to be used to assess the quality of doctors.

So far there have been relatively few objections raised to the proposed measures, including from doctors, whose trade group, the American Medical Association, applauded the deal.

Instant Insights /

Do outcome-based payments punish hospitals in poor areas?

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