Objective To examine the effects of Medicaid Home and Community‐based Services (HCBS) waivers on reducing racial/ethnic disparities in unmet need for services among families of children with autism spectrum disorder (ASD). Data Sources Data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health and the 2005 and 2010 waves of the National Survey of Children with Special Health Care Needs were used. Data on waiver characteristics were collected from source materials that were submitted in support of each state's waiver application. Waiver characteristics were combined to create a single waiver generosity variable. Study Design Quasi‐difference‐in‐difference‐in‐difference models were used to determine the effect of waiver generosity on racial/ethnic disparities in unmet need among children with ASD. Principal Findings Increased waiver generosity was associated with significantly reduced odds of having unmet need for black children with ASD compared with white children with ASD. Unmet needs among black children with ASD were roughly cut in half, a 13 percentage point decrease, with the implementation of an average generosity waiver. No significant differences were seen for Hispanic ethnicity. Conclusion These findings suggest that Medicaid HCBS waivers have the potential to ameliorate disparities in unmet need among children with ASD. Future policy development should focus on replicating the most effective characteristics of these waivers.

Nationally, there is strong interest in measuring hospital performance in patient safety. The Leapfrog Group uses a survey, along with other data sources, to calculate patient safety scores for 2600 hospitals across the United States. Under this methodology, every hospital is assigned 1 of 5 letter grades (A, B, C, D, F) depending on how the hospital stands in safety performance relative to all other hospitals. The results have been widely marketed and disseminated to employers, payors, and the public. Leapfrog strongly encourages employers and payors to negotiate hospital reimbursement rates based on the safety grade the hospital receives. Leapfrog's effort to develop a standardized method to provide patient safety information should be commended. However, less than one‐half of the 2600 hospitals participated in the Leapfrog survey. For those nonparticipating hospitals, certain safety measures were absent and alternative measures were used to calculate the safety score. A sample of the nation's most prestigious hospitals (n = 35) was drawn from the U.S. News & World Report's “Best Hospitals.” Overall, the group of participating hospitals (n = 18) received an average grade of A (mean safety score = 3.165), whereas the group of nonparticipating hospitals received an average grade of B (mean safety score = 3.012). These nonparticipating hospitals were rescored using the methodology for participating hospitals. The results show that the majority of nonparticipating hospitals would have received a better safety grade. This demonstrates a potential shortcoming of Leapfrog's method and its tendency to discriminate against nonparticipating hospitals. Journal of Hospital Medicine 2014;9:111–115. © 2014 Society of Hospital Medicine

Publicly reported hospital performance data have become widely available to health care consumers in recent years. In response to a growing demand for more readily available health care information, various organizations have begun assessing hospital performance. These performance reporting systems have tremendous potential to aid patients, families, and primary care providers in their clinical decision making. This study takes a systematic approach to review the main features of 9 existing hospital rating systems, each of which is described using 9 areas of evaluation. The hospital rating systems included in this study vary widely in scope, methodology, transparency, and presentation of their results. Their results often present conflicting conclusions regarding the performance of the same hospital. This review of hospital rating systems demonstrates how public reporting may add confusion to patients' health care decision making.