Patient satisfaction rises in importance for hospitalists
Ask any expert on patient satisfaction why hospitalists should care about this issue and they all say the same thing: It’s the right thing to do.
But increasingly, it’s also the smart thing to do from a financial perspective. Most of the financial levers involved are aimed at hospitals, but they tend to trickle down to physicians.
Hospital value-based purchasing is one of the biggest drivers. Under the new program, which began in October 2012, hospitals have a small percentage of their total Medicare charges set aside into a pool used for awarding value-based incentives. Medicare officials measure the hospitals’ performance on a set of process of care measures and on patient satisfaction to determine the amount of the incentive. Depending on their performance, hospitals may earn more or less than what Medicare originally withheld for the incentive pool.
The government began the program by withholding 1% of total Medicare charges, increasing every year until reaching 2% in October 2016.
The program puts a hefty emphasis on patient satisfaction with 30% of the total score coming from performance on patient satisfaction. Medicare officials are using eight dimensions of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores as the basis for grading performance on patient experience.
Even 1% can be a lot of money depending on the size and patient mix of the institution, said Dr. Peter H. Short, a former pediatric hospitalist and chief medical officer at Northeast Hospital Corp., a 258-bed community hospital network in Beverly, Mass., and a member of Lahey Health.
For instance, a hospital with $300 million in annual operating revenue could have about $150 million coming in from Medicare. That means that $1.5 million is at risk through the hospital value-based purchasing program, which puts a heavy emphasis on patient satisfaction.
"That’s nothing to sneeze at," Dr. Short said. "You don’t want to lose that."
And Medicare isn’t the only payer that is attaching dollars to patient satisfaction. More and more private insurers are including patient satisfaction scores as part of their pay for performance programs for hospitals, Dr. Short said.
All of this means that patient satisfaction is on the radar screen for hospital executives. And they in turn are leaning on hospitalists to make gains in HCAHPS scores.
In 2012, 71% of adult hospitalists with a performance incentive reported that they had measures related to patient satisfaction in the incentive, up from 54% in 2008, according to data collected by the Society of Hospital Medicine (SHM).
"Hospital executives are saying, we’re paying a couple million dollars for this hospitalist program, we want them to be the solution to patient experience. Let’s incentivize that," said Dr. Winthrop F. Whitcomb, medical director of health care quality at Baystate Medical Center in Springfield, Mass., and a past president of SHM.
Training for better satisfaction
In some institutions, hospitalists are actively training to do a better job at patient satisfaction. At Baystate Medical Center, simulations for good doctor-patient interactions are performed just as surgical ones are.
This spring, hospitalists there viewed a training video where they learned tactics for putting patients at ease and earning their trust. The strategies included everything from sitting down and making eye contact to providing patients with a business card with the physician’s photo. After that, hospitalists went into the simulation lab to sit down with former patients and act out common situations.
Dr. Whitcomb, who went through the training himself, said physicians introduced themselves, went through the details of a case, and in some cases explained test results. At the end of the simulation, the hospitalists got feedback on their performance.
The new training has been a hit with hospitalists and could be expanded to other physicians next, Dr. Whitcomb said.
At Northeast Hospital Corp., a 4-day workshop was recently conducted for hospitalists, nurses, case managers, and pharmacists at their Beverly, Mass., hospital. Actors were brought in to portray patients and family members, and the provider teams had a chance to simulate conversations with families.
A survey of providers after the workshop found that most providers thought they did a good job at the outset, but that they learned something to help them do a better job next time, Dr. Short said.
The next step will be to measure the hospital’s HCAHPS scores over the next few months to look for improvement, Dr. Short said.
