Safety Net Hospitals in Health Systems: Variation in ACO Participation and Other Characteristics

Publisher: Washington, DC: Mathematica
Jul 03, 2019
Rachel M. Machta, Michael F. Furukawa, Jessica Heeringa, David J. Jones, Justin Timbie, Ashley M. Kranz, Valerie A. Lewis, and Eugene C. Rich

In recent years, hospitals and physicians have increasingly consolidated into health systems. Safety net hospitals may join or form health systems to bolster their financial stability, position themselves to succeed under alternative payment models, or fulfill their strategic mission of providing more comprehensive care to their communities. Using data from the Agency for Healthcare Research and Quality’s Compendium of U.S. Health Systems, we examined how the characteristics of safety net hospitals vary based on whether they are part of systems and, if they are, on the size of those systems. Compared with safety net hospitals outside of systems, those that are in systems:

  • Are relatively large, as measured by bed size
  • Provide more graduate medical education, as measured by resident-to-bed ratios
  • Are more likely to join an accountable care organization
  • Are more commonly owned by investors or religious not-for-profit entities
  • Have healthier operating margins
  • Provide more essential health care services

Coordinating Center for Comparative Health System Performance


U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality

Time Frame


Senior Staff

Rachel Machta
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David Jones
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Jessica Heeringa
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Eugene Rich
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