Rating the best hospitals has become commonplace, with U.S. News & World Report, various research firms and lots of websites routinely issuing rankings.

Now some health researchers have come up with a way to evaluate which hospitals are the worst. In a paper just published in the policy journal Health Affairs, three researchers classified 3,229 hospitals by quality, using Medicare's reports of how often each hospital followed recommended guidelines of care for basic things like giving heart attack patients aspirin upon admission.

Next, the researchers evaluated the hospitals by how much they spent providing care. Combining the two ratings, they identified 178 low-quality, high-cost institutions. With refreshing bluntness, they designated those as the "worst" hospitals.

The researchers found that the worst hospitals had similarities. They tended to be small public hospitals and for-profit institutions in the South. They treated twice as many elderly, black patients as did the 122 "best" hospitals (those that provided high-quality care at a low cost).

The worst hospitals also had many more Medicaid patients than the best. Being a "worst" hospital had significant implications. Heart attack and pneumonia patients at the worst hospitals were more likely to die than those at the best.

Now, we know what you're thinking. Which hospital was the worst and which was the best? Sorry to disappoint you, but researchers didn't publish the names, a condition of getting the detailed data from Medicare they needed for the analysis.

Still, their conclusions are pretty important because Medicare is moving ahead with changes to the way it pays hospitals. Those that provide high-quality care cost-effectively will get rewarded at the expense of those that provide substandard care at a high price.

That approach was required by the federal Affordable Care Act. But, this study warns, it could end up hurting hospitals that treat lots of poor, black patients, undermining efforts to reduce disparities in care.

"As hospital payments are reduced over time, becoming more efficient while maintaining quality will become even more important," the study says. "Whether poor-performing hospitals will lose part of their reimbursement — possibly even going out of business as a result — or institute new and effective quality improvement efforts is unclear."

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