This article appears in the June issue of HealthLeaders magazine.
Do hospitals that treat more low-income, ethnically diverse patients with multiple comorbidities have a tougher time getting good patient experience scores than other hospitals, as some organizations contend?
And if so, should those hospitals merit an adjustment for socioeconomic status or payer mix, especially when millions in value-based purchasing incentive pay is now at stake?
Safety-net advocacy groups say the Hospital Consumer Assessment of Healthcare Providers and Systems surveys should be adjusted for race, ethnicity, income, and health literacy as well as insurance status because HCAHPS misses a measure of hospital cultural competence.
But to date, the Centers for Medicare & Medicaid Services has disagreed, arguing that existing adjustments—such as for age, education, and the patient's primary language—are adequate.
Besides, CMS said in its 2013 payment rule, one-fourth of hospitals with large safety-net populations show they do just fine on patient experience.
Executives of several hospitals that treat larger shares of these populations have grappled with this issue, and they, too, think it can be done. Although it can be tough. One of those is 520-bed Ronald Reagan UCLA Medical Center in Los Angeles, which acknowledges an uphill climb in a "melting pot" of patients.
"We do more organ transplants than any other hospital in the United States. We invented the PET scan, diagnosed the first case of AIDS, and we're about to do a face transplant," says David Feinberg, MD, MBA, president of the UCLA Health System and CEO of the UCLA Hospital System. "We're world famous."
"But five years ago, if you asked patients to rate UCLA on a patient experience score of 1 to 10, we were in the 30th percentile, and our emergency department was in the 17th. Basically, we could save your life, but two out of three people would never come back."
After a few months of sitting near patients' beds listening to their experiences, Feinberg says, he got an earful. "It was very clear: No one knew who was in charge of their care. The place was dirty. The hot food was never hot. The cold food was never cold."
And providers were arrogant, conveying the attitude, " 'We're UCLA. Aren't you lucky you get to see us.' That came across in how we treated ourselves and certainly how we treated our patients and their families," Feinberg says.
When he was named system CEO in 2007, Feinberg says, "I told the organization, 'We are really going to change this. We're going to treat patients with compassion.' "