Medicare releases hospital patient satisfaction data

Before choosing a hospital for an elective procedure, patients can now use the Centers for Medicare and Medicaid Services’ Hospital Compare Web Site to see how former patients rated their experiences at various hospitals. Patients can compare hospitals based on how well patients felt the doctors and nurses listened to them, whether the patients felt respected by the hospital staff, and whether patients understood the instructions on what to do after leaving the hospital.

Patients can also use the Hospital Compare Web site to compare how many patients were treated for heart attacks, pneumonia, and various surgeries at nearby hospitals and see how much Medicare paid.

These are the federal government’s latest steps to promote "value-driven health care."

"Everyone ought to have a motivation to get better quality and lower costs," said Michael Leavitt, secretary of the U.S. Department of Health and Human Services.

CMS launched the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data Friday before a group of hundreds of journalists gathering in Washington D.C. for an annual conference.

Leavitt spoke of the need to transform the current "health care sector" into a "health care system" that is not based on volume but on value. While acknowledging that the quality measures are "still rather clunky," the Secretary said that they will become increasingly sophisticated, and by using them, the public can demand accountability.

That accountability, he continued, is crucial to improving quality and decreasing efficiencies, which can lead to lower costs. Controlling health care costs, he said, is critical to the United States’ ability to be competitive in a global market.

"Health care is beginning to undermine the capacity of our country to be competitive," Leavitt said, referring to last week’s projections that spending at the current rate could deplete the Medicare trust fund by 2019.

CMS says it has three broad goals with the HCAHPS data: 1) to provide meaningful and objective hospital comparisons on topics that are important to consumers; 2) to create incentives for hospitals to improve the quality of patient care; and 3) to enhance accountability through transparency.

Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHQR), called the site an "invaluable tool for picking the best hospital for your needs."

"Patient perspective on care is a critical part of quality," Clancy said, using the example of a patient who cannot follow hospital discharge instructions because they weren’t explained in a clear way. That patient, she said, is likely to be readmitted to the hospital for an added, unnecessary expense.

About 20 percent of surveyed patients said they didn’t receive written instructions at discharge. As for feeling respected, 84 percent of patients felt their physician treated them with respect but only 77 percent said nurses did.

Data from about 2,500 hospitals is currently available. CMS said its goal is to have at least 300 surveys completed per hospital and to add hospitals. Hospitals must collect and report their survey results if they want to receive annual 2 percent Medicare payment increases.

The surveys reflect the experiences of all hospital patients older than 18, but the cost and volume data is for Medicare patients only. Gerry Shea, of AFL-CIO’s government affairs division and part of the Hospital Quality Alliance, said the future hope is to have similar measures for patients with commercial insurance. Leavitt said he hopes Medicare’s leadership on transparency and quality permeates the entire health sector.

CMS and AHQR began developing the survey in 2002. The National Quality Forum, a private nonprofit dedicated to creating evidenced-based national standards to improve patient care,  endorsed the survey in 2005. The survey asks patients 27 questions about aspects of their hospital experience, such as communication with staff, staff responsiveness, cleanliness, pain management, medication instructions and discharge information. The data is adjusted based on the type of survey (telephone or paper) and the patient’s age and health status. This initial data launch is based on surveys taken between October 2006 and June 2007.

While it will hopefully be a useful resource to help patients make decisions about hospitalizations, Hospital Compare should be one of many factors taken into consideration, said Rich Umbdenstock, president and CEO of the American Hospital Association.

SEE ALSO: Sliding Down the Back Side of the Health Care Quality Curve: Who’s at Greatest Risk?, by Brian Smedley March 28, 2006

8 replies »

  1. Hiya, I am really glad I have found this information. Nowadays bloggers publish only about gossips and net and this is really irritating. A good website with interesting content, this is what I need. Thanks for keeping this website, I will be visiting it. Do you do newsletters? Can’t find it.

  2. I believe that the most impactful, behavioral changing training comes from very fundamental concepts that are presented in a highly interactive and engaging manner. This patient satisfaction program uses universal examples that everyone can relate to, presented in a highly graphical format the people remember for the rest of their lives; and will use on a daily basis with other clinicians and patients alike. The breakthrough technology focuses in on fundamental barriers to communication and successful relationships in the hospital, in order to build a more positive and supportive team environment that results in substantially improved patient satisfaction scores as well a quality improvements in clinical care.

  3. I agree with Ian’s observation that patient satisfaction is often driven by factors other than outcomes. In a recent survey of healthcare professionals that I analyzed physician courteousness, staff courteousness and physician reputation were the three most important characteristics the respondents desired to find in their primary care providers. What is less obvious, though, is that patients who find that their physicians rate well in these categories follow instructions better; that is, physicians who rank high in these characteristics tend to have better outcomes with their patients because of positive patient response in both following directions and working with the physician to identify and treat their medical conditions.

  4. The problem with the hospital compare data is that, just like the website for nursing homes, the ‘quality indicator’ data is SELF-reported, UNaudited data….therefore, it’s reliability is extremely suspect.

  5. Here we go again with “survey says”, is it valid. Depends on the question and who is asking/who is giving. I think surveys are fine but they only give you a lead to follow, not the whole story. Case in point would be my wife’s hospital. Nurses are given an anonymous “rate your manager” survey once a year. My wife’s unit managers consistantly get below, “grade level” answers. But her unit always meets or gets below budget and outperforms every other unit on patient care and efficiency. The worst performing unit with the least effective managers gets the highest “we like our managers” review. When they delve deeper into the complaints they find many of the nurses just don’t want managers, they want enablers. So which hospital unit would you rather go to?

  6. Patient satisfaction is an important factor in quality care but what drives patient satisfaction is not outcomes. Their are two main problems.
    First the way patients rate “good” care is dependant on the type of procedure they are having. People will be more understanding of bad service for more complicated procedures. If you assume that similiar size hospitals will have roughly the same group of specialities then this could be a non-issue.
    The second and more important factor is that most of the variation seen in patient satisfaction surveys is driven by tangilble factors not outcomes. Things like wait times, physical environment, personnalities, etc… have a greater impact on these rating systems than outcomes do.
    Most people will not know how to interpret these measures, so the responsability falls to the agency that’s collecting the data to provide context to the consumer.

  7. This is a step in the right direction but has been a long time coming around utilizing a standardized instrument to collect patient satisfaction ratings for hospitals. The issue now is there going to be standardization among individual physician ratings utilizing the CAHPS Clinician & Group Survey.
    Regardless patient satisfaction ratings have two important limitations including:
    1. Lack of evidence in the medical literature with direct link to clinical outcomes
    2. Ceiling effects which make it difficult for patients/consumers to really distinguish if there is a meaningful difference between two providers.
    BTY – CMS needs to hire some web designers and graphic artists. The Hospital Compare website has been a real clunker from a visual and navigation standpoint since its inception.