Satisfied Patients Now Make Hospitals Richer, But Is That Fair?
In Medical Park Hospital in Winston-Salem, N.C., Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer gently jokes with her. When Koons says she's itchy under her cast, Cammer warns, "Do not stick anything down there to scratch it!" Koons smiles and says, "I know."
Koons tells me Cammer's kind attention and enthusiasm for nursing has helped make the hospital stay more comfortable.
"They've been really nice, very efficient, gave me plenty of blankets because it's really cold in this place," Koons says. Koons and her stepfather, Raymond Zwack, agree they'd give Medical Park a perfect 10 on the satisfaction scale.
My poll of the family is informal, but Medicare has been taking actual surveys of patient satisfaction, and hospitals are paying strict attention. The Affordable Care Act ties a portion of the payments Medicare makes to hospitals to how patients rate the facilities.
Medical Park, for example, recently received a $22,000 bonus from Medicare in part because of its sterling results on patient satisfaction surveys.
Novant Health is Medical Park's parent company, and none of its dozen or so other hospitals even come close to rating that high on patient satisfaction. Figuring out why Medical Park does so well is complicated.
First, says Scott Berger, a staff surgeon, this isn't your typical hospital.
"It kind of feels almost like a mom-and-pop shop," he says.
Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and most of their patients have insurance.
Another key is that no one at Medical Park was rushed to the hospital in an ambulance or waited a long time in the emergency room. In fact, the hospital doesn't even have an emergency room.
The hospital doesn't tend to do emergency surgeries, says Chief Operating Officer Chad Setliff. These procedures are all elective, scheduled in advance. "So they're choosing to come here," he says. "They're choosing their physician."
These are the built-in advantages that small, specialty hospitals have in terms of patient satisfaction, says Chas Roades, chief research officer with Advisory Board Company, a global health care consulting firm.
"A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals]," Roades says.
This is the third year hospitals can get bonuses or pay cuts from Medicare — partly determined by those scores — that can add up to hundreds of thousands of dollars.
More typical hospitals that handle many more patients — often massive, noisy, hectic places — are more likely to get penalized, Roades says.
"In particular, the big teaching hospitals, urban trauma centers — those kind of facilities don't tend to do as well in patient satisfaction," he says. Not only are they busy and crowded, but they also have many more caregivers interacting with each patient.
Still, Roades says, although patient surveys aren't perfect, they are fair.
"In any other part of the economy," he points out, "if you and I were getting bad service somewhere — if we weren't happy with our auto mechanic or we weren't happy with where we went to get our haircut — we'd go somewhere else." In health care, though, patients rarely have that choice. So Roades thinks the evaluation of any hospital's quality should include a measurement of what patients think.
Medical Park executives say there are ways big hospitals can seem smaller — and raise their scores. Sometimes it starts with communication-- long before the patient shows up for treatment.
On my recent visit, Gennie Tedde, a nurse at Medical Park, is giving Jeremy Silkstone an idea of what to expect after his scheduled surgery — which is still a week or two away. The hospital sees these conversations as a chance to connect with patients, allay fears and prepare them for what can be a painful process.
"It's very important that you have realistic expectations about pain after surgery," Tedde explains to Silkstone. "It's realistic to expect some versus none."
Medical Park now handles this part of surgery prep for some of the bigger hospitals in its network. Silkstone, for example, will have surgery at the huge hospital right across the street — Forsyth Medical Center.
Carol Smith, the director of Medical Park's nursing staff, says that after she and her colleagues took over these pre-surgical briefings, "Forsyth's outpatient surgical scores increased by 10 percent."
But some doctors and patients who have been to both hospitals agree that the smaller one is destined to have higher scores. It is just warmer and fuzzier, one patient says.
This story is part of NPR's reporting partnership WFAE and Kaiser Health News.
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