20. Fort Smith, AR-OK
> 30 day readmission rate: 15.8% (highest 25%)
> 30 day mortality rate: 13.4%
> Preventable hospitalizations: 69.6 per 1,000 patients (highest 10%)
> No. of physicians: 74.6 per 100,000
> Median household income: $40,970 (lowest 10%)
Access to hospital care, as indicated by health insurance coverage rates, actually tends to be relatively good across the 25 cities with the worst-rated hospitals. But not in the Fort Smith metro area, where 12.4% of residents do not have health insurance, one of the highest uninsured rates in the nation. Area residents are not especially wealthy. The typical household earns $40,970 annually, and the poverty rate of 18.2% is among the higher poverty rates of all U.S. metros. Unstable financial situations can exacerbate health conditions and increase the risk of future diagnoses. Among other adverse health outcomes, the obesity rate in Fort Smith of 36.2% is 10th highest in the nation.
19. Vineland-Bridgeton, NJ
> 30 day readmission rate: 16.5% (highest 10%)
> 30 day mortality rate: 13.0%
> Preventable hospitalizations: 63.8 per 1,000 patients (highest 25%)
> No. of physicians: 48.1 per 100,000 (lowest 25%)
> Median household income: $49,110
The likelihood of dying during the 30 days after being admitted to a hospital in the Vineland-Bridgeton metro area is only slightly higher than the national average 30-day mortality rate of 12.7%. However, the likelihood of being readmitted during this window, which all things equal should not occur after receiving optimal hospital care, is in the highest 10% of all metro areas.
Recent research by the Association of American Medical Colleges and other organizations has revealed a growing doctor shortage in the United States. The ratio of primary care physicians per population is in some regions considerably lower than it is nationwide, particularly in metro areas with low-rated hospitals. The Vineland-Bridgeton area is one such case. There are 48 doctors per 100,000 area residents, versus the average of 76 doctors per 100,000 people nationwide.
18. Morristown, TN
> 30 day readmission rate: 15.4%
> 30 day mortality rate: 14.0% (highest 25%)
> Preventable hospitalizations: 69.3 per 1,000 patients (highest 10%)
> No. of physicians: 49.7 per 100,000 (lowest 25%)
> Median household income: $44,348 (lowest 25%)
Avoidable hospitalizations and readmissions happen more often when mistakes are made. And mistakes are made more often at hospitals operating under resource, staffing, and other constraints. The proportion of doctors to area residents can therefore help explain the area’s poor hospital ratings. In the case of Morristown, there are fewer than 50 primary care physicians for every 100,000 people, a considerably lower ratio than the average of 76 doctors per 100,000 people nationwide. The low concentration of doctors is likely contributing to the high unnecessary hospitalization rate in the area. With 70 hospitalizations out of every 1,000 considered unnecessary, the area is among the worst 10% in the metric.
As is the case in nearly all of the metro areas with the worst-rated hospitals, the Morristown median household income of $44,348 a year is well below the national income level.
17. Sioux City, IA-NE-SD
> 30 day readmission rate: 15.3%
> 30 day mortality rate: 15.1% (highest 10%)
> Preventable hospitalizations: 47.2 per 1,000 patients
> No. of physicians: 54.0 per 100,000 (lowest 25%)
> Median household income: $56,687
High-income individuals tend to be better able to carry out doctor’s orders, be it exercise, food, or medicine. They are also more often served by higher-rated, better funded hospitals. Sioux City is somewhat of an exception, with the typical household earning $56,687 annually, in line with the national income level of $57,617. Yet, according to one gauge of hospital quality, 15.1% of patients die within 30 days of being admitted to Sioux City area hospitals — one of the highest such percentages of all metro areas.
As is common in metro areas with poorly-rated hospitals, there are only 54 primary care physicians per 100,000 area residents, well below the average nationwide. However, not all medical professionals are not in short supply in Morristown. For every 100,000 people in Sioux City, there are 144 dentists and 390 mental health providers, considerably higher proportions than the national ones of 66 dentists and 200 mental health providers per 100,000 people.
16. Fresno, CA
> 30 day readmission rate: 16.2% (highest 10%)
> 30 day mortality rate: 14.1% (highest 25%)
> Preventable hospitalizations: 42.9 per 1,000 patients
> No. of physicians: 66.0 per 100,000
> Median household income: $48,715
The prevalence of low-income areas on this list suggests that CMS hospital quality assessments may be unfairly penalizing hospitals serving poor communities. Because many low-income patients may struggle to carry out a doctor’s orders — purchasing often expensive medications, for example — unplanned readmissions, deaths, and preventable hospitalizations may, in some cases, not be avoidable with hospital care alone. These scenarios may arise more frequently in the Fresno metro area than elsewhere, as more than 25% of area residents live in poverty. The incidence of preventable hospitalization, at 43 per 1,000 patients, is below the national average, but the 30-day readmission rate of 16.2% of patients is among the higher such figures nationwide. On the other hand, while low-income populations tend to report higher rates of certain adverse health outcomes, Fresno’s obesity rate of 26.3% is one of the lowest in the country.