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Hospitals Struggle to Improve Patient Satisfaction

Facilities feel weight of Medicare surveys

Since Medicare began requiring hospitals to collect information about patient satisfaction and report it to the government in 2007, these surveys have grown in influence, according to a new report from Kaiser Health News. For the past 3 years, the federal government has considered survey results when setting pay levels for hospitals. Some private insurers do so, as well.

In April 2015, the government will begin boiling down the patient feedback into a five-star rating system for hospitals. Federal officials say they hope that will make it easier for consumers to digest the information now available on Medicare’s Hospital Compare website. Hospitals say judging them on a one-to-five scale is too simplistic.

Nationally, the hospital industry has improved in all of the areas that the surveys track, including how clean and quiet their rooms are and how well doctors and nurses communicate. But hundreds of hospitals have not made headway in boosting their ratings, federal records show.

For example, nudging up scores has been a frustrating endeavor at Novant Health, a nonprofit hospital system that runs Rowan Medical Center and 13 other hospitals in North Carolina, South Carolina, and Virginia. While some Novant hospitals have excellent patient reviews, Rowan’s scores have remained stubbornly low since Novant took over the hospital in 2008. The hospital is losing $29,000 this year because of the low scores.

Last fall, Rowan’s president, Dari Caldwell, replaced the physician group that ran the emergency room because the doctors had not reduced wait times. ER waits are down to 30 minutes, a spokeswoman said. Doctors and nurses also are being coached on their bedside manner, such as being advised not to stare at their computer when a patient is talking.

Rowan’s nurses now spend 70% of their time with patients, swinging by every hour. Even the president makes rounds once a day. The hospital has also made several small improvements to provide a warmer environment, such as putting white poster boards in each room where nurses can list a few personal details about their patients.

But that might not be good enough for Medicare, Kaiser says. In determining how much to pay hospitals, the government only gives credit when patients says they “always” got the care they wanted during their stay, such as their pain was “always” well-controlled. If a patient says that a level of care was “usually” provided, it does not count at all. Likewise, the surveys ask patients to rank their stays on a scale of 0 to 10; Medicare only pays attention to how many patients award the hospital a 9 or a 10.

Another challenge for hospitals is that Medicare does not take into account the inexact nature of these ratings, which can be based on as few as 100 patients over a given year. Medicare recommends a minimum of 300 surveys, but even those have imprecisions that Medicare does not highlight when publishing ratings on Hospital Compare, or does not take into account when determining financial bonuses or penalties, Kaiser notes.

In its hospitals with lower ratings, Novant is trying to replicate some of its successes at its Medical Park Hospital in Winston-Salem, a surgical center, which has the best patient satisfaction scores in the Novant system. Sean Keyser, Novant’s vice president for patient experience, interviewed the staff to figure out how it performed so well.

“The first thing they suggested was the relationship between the physician and the nurses,” he said. “They tend to round more together; they tend to huddle more together. It doesn’t matter how long we study health care organizations, personal relationships that caregivers have with each other translates into better relations with patients.”

Staff members at Medical Park now conduct the presurgical discussions for patients at several bigger Novant hospitals. Those preparatory talks, which take place a week or two before planned operations, give nurses the chance to allay fears and to make sure that patients have realistic expectations of what will happen.

Dr. Scott Berger, a surgeon, said the smallness of the hospital — Medical Park has only 22 beds, whereas Rowan has 268 — gives Medical Park an advantage over other hospitals in pleasing patients. “We also think that because we only do surgery here, that we’re really able to have kind of a sharp edge, if you will, of focus on good outcomes and good patient care,” he said. “And that really carries over to the nurses as well. Because all day every day, all they see is the same kind of surgical patients over and over again.”

Source: Kaiser Health News; March 10, 2015.

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