Low HCAHPS Scores at Safety Net Hospitals Examined

Cheryl Clark, for HealthLeaders Media , July 18, 2012

In an accompanying editorial, Mitchell Katz, MD, director of the Los Angeles Department of Health Services and Katherine Neuhausen, MD, a family medicine physician at UCLA, also suggested the new payment penalties in the HCAHPS survey puts safety net hospitals at an unfair disadvantage, and could even "push SNHs closer to the brink of bankruptcy."

They urged the Centers for Medicare & Medicaid Services and state Medicaid agencies to instead design incentive programs that reward safety net hospitals for improving patient experience and quality "before implementing penalties."


"Because safety net hospitals take care of many patients without the ability to pay, some with conditions that require extra resources (e.g. social work, behavioral health care), the hospitals may not have the resources to devote to physical plant improvements or other amenities that affect patient satisfaction," they wrote.

"Long waits due to the heavy demand for services that are not available anywhere else for uninsured or Medicaid patients may result in patients feeling dissatisfied with their care."
Additionally, they questioned whether good scores on patient experience surveys indicate the patients received good quality of care. "In a recent study, higher patient satisfaction was associated with higher expenditures for overall healthcare and prescription drugs as well as increased mortality," they wrote, suggesting that such incentive systems "could have unintended consequences on healthcare utilization and outcomes."

Beth Feldpush, vice president for advocacy and policy for the National Association of Public Hospitals and Health Systems, also has concerns that safety net hospitals are unfairly disadvantaged by the incentive payment penalties.

While her organization supports the HCAHPS tool and is working hard to help its member hospitals improve their scores, "we need to make sure the measures are fair and don't penalize any subset of hospitals based on some subset or characteristic these hospitals have in common.

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