Insurers: Quality Counts Hospitals, Physicians to Face Assessments of Patient Satisfaction

By Toland, Bill | Pittsburgh Post-Gazette (Pittsburgh, PA), July 22, 2012 | Go to article overview

Insurers: Quality Counts Hospitals, Physicians to Face Assessments of Patient Satisfaction


Toland, Bill, Pittsburgh Post-Gazette (Pittsburgh, PA)


If television's "House" and Dr. Perry Cox from "Scrubs" have taught us anything, it's that terrific physicians can have lousy bedside manners. And hospitals with bland food and noisy hallways can still provide quality care.

So what are physicians and hospitals to make of the quality-of- care metrics being rolled out by Medicare and some insurers meant to measure somewhat subjective factors, such as a primary care physician's communications skills, a specialist's common courtesy, a nurse's promptness, a hospital's noise environment and the patient's overall "experience?"

"There really is a range of opinions and perspectives on scoring in general. For some physicians and medical groups, they will embrace this," said Dale Shaller, a health policy consultant from Stillwater, Minn. "Others aren't there yet, and have more skepticism about the importance of this, or the technical methodology."

However they feel about it, they had better get used to it.

As payers -- that is, health insurers and state and federal government health programs -- try to wring more value out of their dollars, they are taking a closer look at not just the quality of that care, but also the patient's satisfaction. Soon they will be paying hospitals and physicians accordingly.

In October, the federal Centers for Medicare & Medicaid Services will begin adjusting the way it reimburses hospitals, trying to account for the quality of care through what's being called the "value-based purchasing" program. It's part of Medicare's broader move away from the traditional, fee-for-service reimbursement model, which pays hospitals for every test, surgery or visit, regardless of the quality.

One obvious way to measure care is by the outcomes -- do sick people get better, are readmissions reduced, are hospital-acquired infections avoided?

Another way to measure quality, though, is by "patient experience."

It may be a more subjective class of measures, but it's an important one, born of data showing that adverse events -- such as hospital readmissions -- often can be traced back to those intangible areas. Hospitals, so concerned about their satisfaction rankings, are beginning to hire "chief experience officers," or CXOs, whose job is to make patient experience a priority.

"There are a lot of studies that show that when patients have a better experience, they have better outcomes," said Kent Bottles, a physician, health care executive and instructor at Philadelphia's Thomas Jefferson University.

"The more progressive doctors realize that this is an area that could use improvement," especially when it comes to communications, Dr. Bottles said. If, for example, a hospital isn't effectively communicating what a patient should be doing after he leaves the office -- diet, exercise, medication regimen -- then that lack of communication can undermine the best of in-clinic care.

Still, despite all the medical literature that points to the importance of good communication, "There's always a concern that the way we measure [patient] engagement may not be totally fair."

It may be particularly unfair for hospitals in depressed areas, by one study's accounting. A July study in the Archives of Internal Medicine finds that so-called "safety net hospitals" -- those that tend to serve poorer areas and patients -- also tend to get poorer satisfaction grades from patients, compared to hospitals in areas with more favorable economic conditions.

The authors wrote that safety net hospitals "performed more poorly than other hospitals on nearly every measure of patient experience and that gaps in performance were sizeable and persistent over time ... The greatest differences were in overall hospital rating."

That finding has financial implications for such hospitals, as Medicare starts calculating a percentage of the hospitals' total reimbursement based on quality-of-care scores, called the Hospital Value-Based Purchasing program. …

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