Hospital patients delivered some disappointing news last week. Only 67% of patients said they would definitely recommend their hospital to friends and family, and 63% gave their hospitals an overall rating of 9 or 10 on a 10-point scale, according to results of the newly unveiled Hospital Consumer Assessment of Healthcare Providers and Systems patient-satisfaction survey.
The HCAHPS survey, which queried patients on 10 different issues, indicates that hospitals have a ways to go before achieving high patient satisfaction. In the industrys lowest score, only 54% of patients said the room was always quiet at night. In its highest score, 79% of patient said their physicians always communicated well. HHS also released what it pays for certain illnesses with the volume of cases treated, whichcombined with the HCAHPS resultsis designed to drive consumer involvement with quality initiatives.
But hospital industry representatives cautioned that the data the HHS used are old, and the HCAHPS survey is conducted differently from how hospitals operate their patient-satisfaction surveys. I wish it was higher, said Redge Hanna, director of service performance for Emory Healthcare, Atlanta, in reference to the 67% satisfaction number. But he noted that the data reported is from a long time ago.
And hospitals remain wary of how the information is presented. Transparency is good when information is accurate and fair; otherwise, it doesnt add any value, said Louis Shapiro, president and chief executive officer of the Hospital for Special Surgery, New York. He said HHS measurements are conducted differently from his hospitals internal patient survey, but overall he wasnt surprised by his hospitals results.
The results were added to HHS Hospital Compare Web site, which already had been reporting on quality process and outcome measurements for hospitals nationwide.
The American Hospital Association, which collaborates with HHS and other public and private organizations in the Hospital Quality Alliance to maintain the comparison Web site, said HCAHPS is only one source of information and cautioned that patients need to talk to their physicians before making a final decision about their care, said Richard Umbdenstock, AHA president and CEO. Patients need to consider a variety of factors, he said. The value comes from making the HCAHPS results part of performance initiatives, Umbdenstock said. The survey is a quality-improvement tool. Thats how they (hospitals) should use it, he said.
HHS Secretary Mike Leavitt unveiled the HCAHPS survey and payments results at a healthcare journalism conference March 28 in Washington. Leavitt said quality-improvement initiatives and the alignment of payment with high performance must continue to grow if healthcare spending is going to be reined in, and increased transparency on the HHS site will help reduce costs while forcing providers to more carefully scrutinize their outcomes.
Posted in one section of the Web site are payment and volume information for certain, select conditions. The data show how often Medicare patients were admitted to hospitals for those conditions and what Medicare paid for those treatments. The payment information, which reflects only reimbursement and not what Medicare patients pay out of pocket, is not new; it has just been moved to the comparison site, according to an AHA spokeswoman. That decision was made independently of the quality alliance, she said.
But the HCAHPS data release is new, and allows consumers to view state and national data as well. More than 2,500 hospitals participated in the initial HCAHPS release. Data are from patients surveyed after hospitals stays that occurred from October 2006 through June 2007.
The Hospital Quality Alliance said it expects the next report will include data from more than 3,000 hospitals. Roughly 4,300 hospitals currently submit process and outcome data to HHS. Data are to be updated quarterly.
While hospitals are used to reporting process and outcome data for their Medicare patients, satisfaction is a new concept, one thats been contentious among providers who are skeptical that a patient-satisfaction measure could be objective (July 23, 2007, p. 27)
Healthcare providers are gearing up for the public relations response from the release of the data and are planning to help patients with interpretation. Mary Nash, chief nursing executive for Ohio State University Health System, Columbus, said the comparison Web site might take patients some time to learn how to use. Theres a lot to maneuver; I think its going to take the average consumer a little while to understand it, she said. The medical centerwhich did not participate in the initial reporting for HCAHPSrecently launched its own data-reporting page on its main Web site, where patients can view quality and outcome information.
Richard Goldberg, vice president of medical affairs at Georgetown University Hospital in Washington, called the release of the survey data a major step forward, but added that the information is still difficult for the general publicand even some expertsto analyze. Still, when coupled with the results from clinical-measure reporting, the patient data provides a much more complete picture of the quality of care that health centers provide. The patient no longer needs to be patient, Goldberg said. The patient is now an active collaborator in their care and choice of options.
Deborah Morrison, vice president of quality improvement and risk management at Providence Hospital in Washington, agreed. While the HCAHPS tool is excellent as a measure of quality perceptions of the patient about their healthcare experience, there are variations in the ranking scales, she said. The numeric scale varies for different questions, she said, meaning that the general public should be extra careful when viewing the data. Patients need to be very aware of these differences in terms of evaluating care, Morrison said.