Under new legislation, Medicare is bringing in a new rule to reimburse hospitals according to patient satisfaction. If patients are not satisfied hospitals may not be paid. Disgruntled patients can dramatically reduce revenue, a troublesome prospect for hospitals, many of which are already facing empty beds because of the recession and pressure from insurers to cap costs.

The legislation is part of the Affordable Care Act that comes into effect in 2012. A part of it matches hospitals against each other to compete for rankings according to patient satisfaction. Those with higher scores will receive more money.

It sounds great in theory, but like many examples of Government meddling, in practice polite mid westerners may boost a relatively middle of the road establishment, while rude New Yorkers or grumpy Californians that are used to saying their piece, maybe sabotage their local healthcare facilities, by being over demanding or too critical and thus cutting their funding off. This, of course, has the possibility to create a vicious circle where funding is cut, facilities standards fall and more complaints role in, leading to less funding yet again.

Dr. James Merlino, chief experience officer at the Cleveland Clinic, said :

“Hospitals are going be punished financially by the federal government
for things they can’t control.”

It appears that the bean counters did very little to assess the ramifications of their theoretical new laws. Some of the nation’s most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and the University of Chicago Medical Center, get lower patient satisfaction scores on most areas of patient experiences, according to the government’s own Hospital Compare Web site.

The same applies in New York, where The New York-Presbyterian Hospital, the Mount Sinai Medical Center and Beth Israel Medical Center all get lower scores, while offering some of the finest most accomplished physicians and medical staff in the world.

Dr. Katherine Hochman, an NYU physician said in the NY Times :

“People in New York have very high expectations about what it means to be taken care of … When they don’t get their food on time and have to spend eight hours in the emergency department, well, that’s just not their image of what a world-class institution is.”

Also, when you think into it logically a busy hospital which has the finest equipment and staff may not give you the best “hotel” experience, but your surgery or other treatment can be first class without you realizing it. How is a patient really able to judge the quality of their medical care, other than with minor details such as the comfort of their bed, the politeness of the nurses or how tasty their meals were?

The ratings will be based on Medicare-approved surveys, in which hospitals hire companies to give to a random selection of patients after they are discharged. Some surveys are done by phone, others by mail. All ask the same questions:

  • Did the doctors and nurses communicate well?
  • Was pain well controlled?
  • Was the room clean and the hospital quiet at night?

The surveys go to both Medicare and younger patients. The federal Centers for Medicare and Medicaid Services plans to be a tough grader when setting payment levels and intends to give hospitals credit only for patients who say their experiences were always good. The surveys also ask patients to rank their stay on a 10-point scale, and Medicare will only credit hospitals that receive a 9 or 10.

Yet another problem that has not been properly thought into is the likelihood that hospitals that manage more complex diseases or trauma will be penalized arbitrarily, since patients generally become less satisfied the longer they are hospitalized for (hence the term patient).

Obviously a small facility offering basic in and out surgeries is going to fair much better than one with intensive care patients and a large cancer ward.

In another great example of the mismatch between patient perception and actual medical care, when NYU moved its cardiology unit to a renovated floor in 2008, patient rankings went up considerably, even though the procedures and staff were the same. Then NYU found that long waits at its elevators drove down its scores, so now it is building a new bank of elevators. Double rooms and cramped emergency rooms invariably lead to more noise and annoyances, but NYU said that it cannot fully solve that until it opens a new building in 2017.

Dr. Robert I. Grossman, NYU’s chief executive officer said he believes that :

“Those amenities are really important …. institutions have total control over the medical quality, and that’s what I think they should be judged on.”

And it does seem a little ridiculous that a coat of paint and a fast elevator ride are going to become almost more important to funding than the quality of the surgeon or the patient mortality rate.

Written by Rupert Shepherd