Patient Experience Scores Skew by Region, Providers Say

A federal proposal to base 30% of hospital "incentive" payments on patient experience scores is receiving strong resistance from providers, who say that patients in some parts of the country are harder to please than others.

8 comments on "Patient Experience Scores Skew by Region, Providers Say"
R Daniel King (1/20/2011 at 7:47 AM)

Presently, hospital organizational culture thrives in two environments: political or accountable. The majority function in a political environment where leadership chooses the politically protected and politically isolated creating a win/lose polarizing environment that fosters dependency and mistrust that leads to failure in patient and financial outcomes. In an environment of accountability everyone is accountable, starting with leadership, creating a win/win innovative environment that fosters interdependency and trust that leads to excellence in patient and financial outcomes. Simply stated, it's the culture stupid, and the dominance of the win/lose political environment where hospital departments function as bunkers where the politically protected fight and scheme to preserve the status quo and the politically isolated struggle and mostly fail to inject excellence. This environment is why hospitals have almost as many annual preventable deaths as all of World War II. That fact alone sums up the patient experience and the only way to lower it is the hospital industry realize it has a leadership chasm that has led to a quality chasm that is unaffordable thanks to the decades of command and control self-serving regulations inflicted by CMS. Until the federal government and hospital leadership accept this fact, because cultural change starts with leadership, the nation's health care delivery system will remain operationally inefficient and quality challenged on a path to economic Armageddon. And nothing in the present design of ObamaCare will deter this ending, if anything it will accelerate it.
Michael Krivich, FACHE, PCM (1/19/2011 at 1:43 PM)

As difficult as this appears to be, providers need to begin looking outside of themselves and using Customer Experience Management to solve this challenege. Individuals are only "patients" 1/3rd of the time you interact with them. The other 2/3rds of the time they are customers. CEM requires the organization to manage the individuals experience across all touch-points beginning to end. Only then when you are actively managing customer experiences and meeting expectations, will you be able to improve satisfaction, revenue and market share. It is not impossible if you apply innovation, creativity and learnings from other industries.
Micahel Krivich (1/19/2011 at 1:29 PM)

It's time for the healthcare industry, namely hospitals and health system to manage customer experiences though customer experience management programs. More than just the "patient" experience, it forces the organzation to understand and manage those experiences enhancing that experience. CEM leads to higher quality, lower cost, increased revenue and market share. It forces an organzation to look outside-in instead of inside-out based on the view of their customers. Individuals aree only patienst in only 1/3rd of the time you interact with them. The other 2/3rds of the time they are consumers. So maybe its time to start lisening to them and using that to drive change.
Steve Wilkins, MPH (1/19/2011 at 11:11 AM)

Change is difficult. No one likes to hear bad news. Wasn't it just last wee that there was an article in this very publication talking about how CEOs were "vague or fussy" on how they planned to improve the patient experience? There are any number of possible explanations for the varaince cited in the article, including size of facility, academic vs. non-academic, intenity of treatement within geographic markets, demographics and so on. Grumpinesss? Please... The fact of the matter is that hospital executives are not ready to deal with what their patients really have to say about the quality of care, service or "patient centeredness." As long as they can keep showing their boards that patient satisfaction is at 90% on their own internal satisfaction polling they are happy. Who cares what that 90% really measures. Hopefully CMS will proceded with the hospital staisfaction incentive program as well as the soon to follow physician satisfaction. incentives.
Bogomil Dabevski (1/19/2011 at 11:05 AM)

For someone who has lived in Minneapolis for a number of years and currently lives in Philadelphia I think that I have some idea as to why people in NY, NJ and PA are least likely to recommend certain medical provider. I am not sure whether the real reason is that the people in NY and PA are grumpier than the ones in MN. I think that it has much more to do with the way people are treated and the attitude they receive in the hospitals in these regions. I can speak for Philadelphia and quite honestly my experience has been horrible. I feel like I live in a third world country when it comes down to dealing with healthcare providers in this city. In my opinion the low quality which hospitals/clinics provide is not due to the quality of their doctors but rather due to their poor management and the quality of the stuff supporting the doctors.
Trisha Torrey (1/19/2011 at 10:39 AM)

Is there any measurement or correlation among these: size of a hospital, these patient experience scores, and rates of infections or medical errors? It would be interesting to see what might be causing the "grumpiness" - because I guarantee that a higher infection rate would bring heightened grumpiness.
Jessica Kennedy (1/18/2011 at 3:28 PM)

What this article does not address is very important. One, Prior to publishing the HCAHPS scores - & going forward, in paying hospitals – CMS does a patient mix adjustment on the data to make sure all patients are essentially counted equally. (Likewise, it also adjust data based on the methodology used to collect it.) I'm not a statistician, but if there were truly statistical differences in the patient populations in regions around the country, I would think CMS knows. It may even be accounting for that in the patient mix adjustments. Second, and perhaps more striking, is that the majority of the data cited in the study and in this article is based on a question that is NOT proposed to be included in the 30% HCAHPS reimbursement. At this time, Would Recommend is not factored in the three ways a hospital can earn its HCAHPS reimbursement - Achievement, Improvement or Consistency. What would be meaningful is to look at CMS published (and adjusted) data and see if these trends are present on the composites and the Overall Rating. Finally, this article maybe be asking the wrong question. Maybe the experience of care patients have is different depending on what institution they're in or where they live. So perhaps this is not a question of patients being grumpy or the problem. Perhaps it is a question that we in healthcare are not equally committed or able to provide patient experiences that meet the expectations of our patients and their families.
Linda Ollis, FACHE (1/18/2011 at 11:48 AM)

Ms. Clark's article is very timely in identifying some of the issues administrators have to deal with in meeting HCAPS targets. Because I've worked in several regions of the country, I've noticed, anecdotally, that results do seem to have regional cultural biases. I applaud Premier and other data reporting organizations for backing up this observation with some real metrics.


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