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‘Patient Satisfaction’ Scoring Puts Some Hospitals at Disadvantage

Study sees need for change in CMS measures

Some predictors of patient satisfaction seem obvious, such as good communication between doctors and patients, but a study published in the Journal of Hospital Medicine shows that some less-obvious predictors put certain hospitals at a disadvantage for patient-experience scoring and, ultimately, for reimbursement, according to an article posted on the HealthLeaders Media website.

Researchers at the Mount Sinai Health System in New York City found that larger hospitals and hospitals where many patients don’t speak English as a first language were predictors of poor Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, whereas white patients and those with higher levels of education were predictors of good HCAHPS scores. That means large, urban hospitals that serve some of the most vulnerable populations are at a disadvantage when it comes to the current scoring system, the article says.

“It's been a long-standing feeling of many people in large academic medical centers that the current system of reporting patient-satisfaction scores is much more difficult for those types of hospitals than for small, rural hospitals,” senior author Randall Holcombe, MD, told HealthLeaders Media. “We wanted to look at this and see if there were any factors that seem to predict patient-satisfaction scores.”

Initially, Holcombe and his co-authors hypothesized that patient-satisfaction scores would track with population density, as previous research has suggested. Indeed, they found that “scores were definitely better in the less-populous states,” he said.

The researchers analyzed HCAHPS survey data from 934,800 patient respondents who were seen at 3,907 hospitals across the country, representing more than 95% of the nation's hospitals. The lowest satisfaction scores were from population-dense regions of Washington, D.C.; New York State; California; Maryland; and New Jersey. The best scores were from Louisiana, South Dakota, Iowa, Maine, and Vermont.

Holcombe noted that the Center for Medicare & Medicaid Services already adjusts for certain factors when determining scores, such as whether patients filled out the surveys by mail or electronically and the age of the respondents.

“Adjusting scores is not a novel concept, [but] there were still additional factors that they could consider adjusting for,” Holcombe said.

In an email to HealthLeaders Media, Sandra Myerson, senior vice president and chief patient-experience officer at the Mount Sinai Health System, agreed, saying, “Specialty surgical hospitals that only provide specific, planned, and elective procedures to insured patients who are well enough to undergo surgery realize a significant advantage [compared] to medical centers that provide care to every patient regardless of their ability to pay for services or their health status upon unscheduled admission, [and] yet CMS does not adjust for these differences.”

Sources: HealthLeaders Media; June 3, 2015; and Journal of Hospital Medicine; May 4, 2015.


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