Measuring Up in Patient Satisfaction

Health care in America has changed radically over the past few decades, and will continue to re-create itself over and over again in the foreseeable future. When I was a little girl, I remember helping my father, a general practitioner, fill out his billing forms. My job was to record office calls by writing "OC $5" in a little slot about a third of way down the page, and by the time I reached high school, it had changed to "OC $7." Back in the 1970s, doctors seemed to be held in much higher regard than they are these days, and patients seemed to willingly accept a passive role in their own health care. It was almost as if they felt that questioning their doctor was simply outside of the realm of what reason and respect.

Today, patients are not only encouraged to ask questions, but their opinion of their doctors also will play a significant role in how much hospitals will be paid for services provided. While the U.S. Department of Health and Human Services has had a website where consumers can compare hospitals for more than 8 years, soon there will be yet another marker for how health care is delivered (and received) in America.

In October, more than 3,000 acute care hospitals will take part in Medicare’s new value-based purchasing program. Under this program, Medicare will reduce payments to hospitals by 1% and put that revenue aside for a bonus pool. In October 2016, that pool will double to 2% of Medicare payments.

Those hospitals that score above average on the measurements chosen or show the greatest improvement in performance during the previous year will receive money from this bonus pool. How much is in this pool? An estimated $850 million in the first year of the program alone.

While 70% of the initial bonuses will be paid based on 12 clinical care measures, the remaining 30% will be patient driven. Some of the proposed topics patients will be asked about include how doctors and nurses communicated with them, how well their pain was controlled, and how clean their rooms were.

"In many ways, it’s a watershed moment for the health care system," said Dr. Ashish Jha, a professor at the Harvard School of Public Health, Boston, who has studied hospital quality. "It’s a modest amount of money and not something that’s going to radically change the way we pay for hospital care in America. But it’s a really important step toward paying for better care and not just for more care."

A recent study lends credence to the hypothesis that patients’ perceptions of hospitals were often tied to the quality of care they received. In an article titled "Associations between Web-based patient ratings and objective measures of hospital quality," (Arch. Intern. Med. 2012;172:435-6) researchers compared hospitals with the best ratings on NHS Choices (a UK website) with those with the worst ratings and found that readmission rates were 11% lower in the higher-rated hospitals than in those with lower ratings, while mortality rates were 5% lower in the higher-rated hospitals. They also found that the hospitals with 25% best cleanliness ratings had a whopping 42% lower rate of MRSA infections than did those with the 25% worst cleanliness ratings.

The bottom line is that "good patient outcomes" are more far reaching than whether patients survived their hospital stay and returned to their prehospitalization state of physical health. Their mental and emotional well-being, as well as their perception of their environment and their overall experience while under our care, need to be a high priority, no matter how busy our days.

Encouraging patients to engage us and share their true fears, likes, and dislikes not only can help strengthen the doctor-patient bond, it can also lead to a better patient experience for the, and a better reputation for the hospitals we serve.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Health care in America has changed radically over the past few decades, and will continue to re-create itself over and over again in the foreseeable future. When I was a little girl, I remember helping my father, a general practitioner, fill out his billing forms. My job was to record office calls by writing "OC $5" in a little slot about a third of way down the page, and by the time I reached high school, it had changed to "OC $7." Back in the 1970s, doctors seemed to be held in much higher regard than they are these days, and patients seemed to willingly accept a passive role in their own health care. It was almost as if they felt that questioning their doctor was simply outside of the realm of what reason and respect.

Today, patients are not only encouraged to ask questions, but their opinion of their doctors also will play a significant role in how much hospitals will be paid for services provided. While the U.S. Department of Health and Human Services has had a website where consumers can compare hospitals for more than 8 years, soon there will be yet another marker for how health care is delivered (and received) in America.

In October, more than 3,000 acute care hospitals will take part in Medicare’s new value-based purchasing program. Under this program, Medicare will reduce payments to hospitals by 1% and put that revenue aside for a bonus pool. In October 2016, that pool will double to 2% of Medicare payments.

Those hospitals that score above average on the measurements chosen or show the greatest improvement in performance during the previous year will receive money from this bonus pool. How much is in this pool? An estimated $850 million in the first year of the program alone.

While 70% of the initial bonuses will be paid based on 12 clinical care measures, the remaining 30% will be patient driven. Some of the proposed topics patients will be asked about include how doctors and nurses communicated with them, how well their pain was controlled, and how clean their rooms were.

"In many ways, it’s a watershed moment for the health care system," said Dr. Ashish Jha, a professor at the Harvard School of Public Health, Boston, who has studied hospital quality. "It’s a modest amount of money and not something that’s going to radically change the way we pay for hospital care in America. But it’s a really important step toward paying for better care and not just for more care."

A recent study lends credence to the hypothesis that patients’ perceptions of hospitals were often tied to the quality of care they received. In an article titled "Associations between Web-based patient ratings and objective measures of hospital quality," (Arch. Intern. Med. 2012;172:435-6) researchers compared hospitals with the best ratings on NHS Choices (a UK website) with those with the worst ratings and found that readmission rates were 11% lower in the higher-rated hospitals than in those with lower ratings, while mortality rates were 5% lower in the higher-rated hospitals. They also found that the hospitals with 25% best cleanliness ratings had a whopping 42% lower rate of MRSA infections than did those with the 25% worst cleanliness ratings.

The bottom line is that "good patient outcomes" are more far reaching than whether patients survived their hospital stay and returned to their prehospitalization state of physical health. Their mental and emotional well-being, as well as their perception of their environment and their overall experience while under our care, need to be a high priority, no matter how busy our days.

Encouraging patients to engage us and share their true fears, likes, and dislikes not only can help strengthen the doctor-patient bond, it can also lead to a better patient experience for the, and a better reputation for the hospitals we serve.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Health care in America has changed radically over the past few decades, and will continue to re-create itself over and over again in the foreseeable future. When I was a little girl, I remember helping my father, a general practitioner, fill out his billing forms. My job was to record office calls by writing "OC $5" in a little slot about a third of way down the page, and by the time I reached high school, it had changed to "OC $7." Back in the 1970s, doctors seemed to be held in much higher regard than they are these days, and patients seemed to willingly accept a passive role in their own health care. It was almost as if they felt that questioning their doctor was simply outside of the realm of what reason and respect.

Today, patients are not only encouraged to ask questions, but their opinion of their doctors also will play a significant role in how much hospitals will be paid for services provided. While the U.S. Department of Health and Human Services has had a website where consumers can compare hospitals for more than 8 years, soon there will be yet another marker for how health care is delivered (and received) in America.

In October, more than 3,000 acute care hospitals will take part in Medicare’s new value-based purchasing program. Under this program, Medicare will reduce payments to hospitals by 1% and put that revenue aside for a bonus pool. In October 2016, that pool will double to 2% of Medicare payments.

Those hospitals that score above average on the measurements chosen or show the greatest improvement in performance during the previous year will receive money from this bonus pool. How much is in this pool? An estimated $850 million in the first year of the program alone.

While 70% of the initial bonuses will be paid based on 12 clinical care measures, the remaining 30% will be patient driven. Some of the proposed topics patients will be asked about include how doctors and nurses communicated with them, how well their pain was controlled, and how clean their rooms were.

"In many ways, it’s a watershed moment for the health care system," said Dr. Ashish Jha, a professor at the Harvard School of Public Health, Boston, who has studied hospital quality. "It’s a modest amount of money and not something that’s going to radically change the way we pay for hospital care in America. But it’s a really important step toward paying for better care and not just for more care."

A recent study lends credence to the hypothesis that patients’ perceptions of hospitals were often tied to the quality of care they received. In an article titled "Associations between Web-based patient ratings and objective measures of hospital quality," (Arch. Intern. Med. 2012;172:435-6) researchers compared hospitals with the best ratings on NHS Choices (a UK website) with those with the worst ratings and found that readmission rates were 11% lower in the higher-rated hospitals than in those with lower ratings, while mortality rates were 5% lower in the higher-rated hospitals. They also found that the hospitals with 25% best cleanliness ratings had a whopping 42% lower rate of MRSA infections than did those with the 25% worst cleanliness ratings.

The bottom line is that "good patient outcomes" are more far reaching than whether patients survived their hospital stay and returned to their prehospitalization state of physical health. Their mental and emotional well-being, as well as their perception of their environment and their overall experience while under our care, need to be a high priority, no matter how busy our days.

Encouraging patients to engage us and share their true fears, likes, and dislikes not only can help strengthen the doctor-patient bond, it can also lead to a better patient experience for the, and a better reputation for the hospitals we serve.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.