Indeed, New York hospitals are very concerned about the 30%. "We believe that even 20% is far too high," says Vincent Fitts, associate vice president of informatics for the Greater New York Hospital Association.
"Wholly separate from the apparent regional bias in HCAHPS results and the fact that large urban hospitals generally fare worse, the current formula penalizes hospitals that treat a higher-than-average percentage of patients for whom English is a secondary language – even though they tend to express satisfaction with their care," Fitts says.
"We simply don't think HCAHPS scores accurately reflect patient experience in the New York metropolitan area."
The American Hospital Association has also weighed in. "We are still evaluating the proposal, but our first reaction is that 30% seems to be a bit high for the HCAHPS proportion," says Marie Watteau, AHA spokeswoman.
In addition to a so-called "grumpiness" variable, Press Ganey surveys indicate that size is a factor in patient responses. Patients in the smallest hospitals, those with 50 or fewer beds, are the most likely to recommend their care (73%), perhaps out of community loyalty and because they know their caregivers personally, while patients in hospitals with 600 or more second most likely to recommend. Hospitals with 150-299 beds have patients least likely to recommend, 66%.
Based on a separate category addressing the patient's communication with nurses, the Press Ganey survey found that patients in hospitals with 50 or fewer beds are also most likely to be pleased with their care enough to recommend the hospital.