Patient satisfaction plays role in Medicare reimbursement

Patient satisfaction now counts more than ever for hospitals.

On Saturday, hospitals around the country completed their very first “performance period,” a nearly year-long evaluation that will affect the amount of money Medicare reimburses them for patient care.

Called value-based purchasing, the program is a part of the Affordable Care Act.

Under the plan, Medicare cut payments to more than 3,000 acute care hospitals by 1 percent. That money was placed into a bonus pool, and hospitals that show improvements or meet certain medical quality measurements will re-earn the 1 percent and possibly bonuses.

Hospitals won’t know until October how they did.

While the majority of the evaluation -- 70 percent -- is based on medical care benchmarks, 30 percent of the bonuses are based on Patient satisfaction scores.

In other words, hospitals not only have to show they are providing top care, but they have to ensure that their patients are happy with their experiences.

The program is an attempt to save taxpayer money by lowering Medicare costs, said Bill May, chief executive of Black Hills Surgical Hospital in Rapid City.

If hospitals prevent mistakes by following the medical care benchmarks set forth in the program, it could prevent costly medical complications down the road. For instance, if a Medicare patient receiving a hip replacement develops a hospital-acquired infection, Medicare will be stuck with additional costs to treat that infection. If the infection never occurs due to appropriate care, it is a win/win for everyone, May said. Before, hospitals were not penalized for bad care, he said.

“It’s a good thing,” May said. “It makes everybody step up their program.”

The Patient satisfaction element of the program adds another layer.

Medical facilities that are cognizant of a patient’s experience are more likely to provide good care, which can even affect the bottom line of a health care facility, said Suzanne Koehler, vice president of operations at Rapid City Regional Hospital.

“It trickles down,” she said.

Under the value-based purchasing program, all hospitals are compared across the board, whether it is Mayo Clinic or Regional Hospital. But Patient satisfaction is based on past scores for each individual facility.

Regional Health also has hospitals in Custer, Deadwood, Spearfish and Sturgis.

Tim Sughrue, chief executive of Regional Hospital, said the hospital has been collecting Patient satisfaction information for two decades. About 15 years ago, it began using an outside company.

Last year, the hospital moved away from “paper and pencil” surveys to a more elaborate Patient satisfaction collection process administered by a Tennessee company named HealthStream Research, Sughrue said.

The hospital also has three full-time employees who work solely in customer service.

Patients receive telephone calls from HealthStream about their care. Patients can record a message if they wish, which can be heard by customer service representatives and often Regional Hospital administration, said Koehler.

In addition to the telephone surveys, the hospital has also worked with staff to improve patient experiences, Sughrue said.

For instance, doctors are now asked to sit down when talking to patients and make eye contact.

“The data has suggested doctors interrupt at 18 seconds,” Sughrue said. The simple gesture of sitting can change that.

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Nurses are asked to involve patients in their shift change briefing. Nurses now also must make hourly rounds of their patients and discharge telephone calls to patients.

May said the Surgical Hospital also paid close attention to Patient satisfaction long before the new Medicare evaluations. And their attention to Patient satisfaction has garnered high scores, he said.

On Hospital Compare, a website of the U.S. Department of Health and Human Services, the Surgical Hospital rated higher in Patient satisfaction than national and state averages -- 87 percent of patients ranked the hospital a nine or 10.

While those scores are great, they have created a bit of a challenge under the new program, May said.

The new value-based purchasing model sets goals for hospitals based on past scores.

“In a way, they customize it for the hospitals,” May said. “If you started out low, it’s easier for you to meet the benchmarks. … You’re only as good as your last score.”

Despite the challenges for his hospital, May still believes the value-based purchasing will prove to be a good thing for health care overall.

“We believe that the program is beneficial because it pushes all hospitals,” he said. “It translates into better outcomes, which saves money for all of us taxpayers.”

May said private insurers are also picking up the value-based purchasing model, which will further promote quality and Patient satisfaction, he believes.

“It is sound policy as a way to reduce health care costs,” he said.

Neither the Surgical Hospital nor Regional Hospital will know how their scores will affect their reimbursement until October, when Medicare releases that information. But there is little down time. Hospitals will begin their next value-based purchasing evaluation period in July.

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