A new study casts doubt on a major principle underlying a good deal of recent federal health care policy.

That principle holds that hospitals that have lower rates of 30-day readmissions of Medicare patients provide better, more economical care than those with higher readmission rates.

But that may not be true.

According to an examination of the performance of safety-net hospitals in California published in the journal Health Affairs, those safety-net hospitals are more likely than others to be penalized by Medicare’s hospital readmissions reduction and value-based purchasing programs.

At the same time, however, these same hospitals had lower 30-day, risk-adjusted mortality rates for patients treated for myocardial infarction, heart failure, and pneumonia.  The safety-net hospitals also had marginally lower adjusted Medicare costs.

The National Association of Urban Hospitals has long been concerned about the bias of value-based purchasing and readmissions reduction programs against safety-net hospitals because of the more challenging patients those hospitals serve and has supported legislation to add a risk-adjustment component to such programs.

Find out more about the findings of the study “California Safety-Net Hospitals Likely to be Penalized by ACA Value, Readmission, and Meaningful-Use Programs,” which can be found here, on the web site of the journal Health Affairs.