“I’m a great kvetcher,” said Pearl Schwartz, sitting in her hospital bed at NYU Langone Medical Center.
Indeed, during her brief stay to receive a pacemaker, Ms. Schwartz, an 88-year-old retired state worker, had a litany of complaints. Sure, the nurses were “splendid, warm and kind” and sang in her room — and her operation went off without a hitch. But her sink was too small, she had to wait eight hours in the radiology unit for an X-ray, and no one brought her anything to read as she had requested.
“If people are down here, wouldn’t it be nice if they could look at a cheerful magazine?” she asked.
Winning praise from patients has become a pressing — and often elusive — obsession for NYU and for hospitals nationwide. In the coming months, Medicare will start taking patient satisfaction into account when reimbursing hospitals. Disgruntled patients will mean reduced revenue, a frightening prospect for hospitals already facing empty beds because of the recession and pressure from insurers to hold down costs.
Medicare’s new rule, mandated in the Affordable Care Act, pits hospitals against one another in a competition to best satisfy patients; those with the best scores will receive more money.
But some hospitals are worried that assessments from patients like Ms. Schwartz can be influenced not just by the quality of their care, but also by amenities like single rooms, renovated units and tasty food. And hospitals in cities and certain regions, like the Northeast and California, tend to get lower ratings, raising concerns that their revenues will be reduced simply because patients in those places are more disposed to grumble about things that a polite Midwesterner or Southerner would forgive.
“Hospitals are going be punished financially by the federal government for things they can’t control,” said Dr. James Merlino, chief experience officer at the Cleveland Clinic.
Surprisingly, some of the nation’s most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and the University of Chicago Medical Center, get lower marks from patients on most areas of patient experiences, according to the government’s Hospital Compare Web site.
So do many of New York City’s elite institutions, including NewYork-Presbyterian Hospital, the Mount Sinai Medical Center and Beth Israel Medical Center. Some hospitals, like NYU, get bad patient reviews even as they score average or superior in measures of clinical care from the government and accreditation groups.
“People in New York have very high expectations about what it means to be taken care of,” said Dr. Katherine Hochman, an NYU physician. “When they don’t get their food on time and have to spend eight hours in the emergency department, well, that’s just not their image of what a world-class institution is.”
The ratings are based on Medicare-approved surveys, which hospitals hire companies to give to a random selection of patients after they are discharged. Some surveys are given by phone, others by mail. All ask the same questions: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? The surveys go to younger patients as well as Medicare beneficiaries.
In setting payment, the federal Centers for Medicare and Medicaid Services plans to be a tough grader. It is going to give hospitals credit only for patients who say their experiences were always good. The surveys also ask patients to rank their stays on a 10-point scale, and Medicare will credit only hospitals that receive a 9 or 10.
That is likely to be a tough threshold for hospitals. Interviewed weeks after her stay, Ms. Schwartz was much more positive about her experience, saying she had “a wonderful time,” but still she was not sure whether NYU deserved more than eight points.
Hospitals’ initial scores will be based on reviews by patients discharged since last July. Starting next October, the federal agency will withhold 1 percent of Medicare’s regular reimbursements to most hospitals and redistribute that money based on how they performed compared with other institutions and how much they improved from the previous year. The bonus amount will rise to 2 percent in 2016.
The agency has decided that patient experience ratings will determine 30 percent of the total bonus payments, more than the hospital lobby favored. The other 70 percent will be based on how hospitals follow clinical guidelines for care, like giving the right medications to avert blood clots and infections.
The agency hopes that commercial insurers will also incorporate patient experience scores into their payments. One major insurer, Wellpoint, already has.
Hospitals have long catered to patients in an effort to draw more customers and beat out competitors. It is one of the reasons so many renovate and rebuild. Many are finding that small changes, like having nurses visit rooms hourly, often improve patients’ responses to the surveys more effectively than do new hotel-like amenities.
Jefferson Regional Medical Center in Pittsburgh expects all employees, from maintenance workers to doctors, to respond to a patient’s call light or find someone to offer assistance. In Los Angeles, Cedars-Sinai is testing new patient call buttons that ring directly to nurses’ cellphones. If the nurse’s line is busy, the call automatically rolls over to another worker’s phone.
Many hospitals have devised detailed scripts that doctors and nurses follow when interacting with patients, telling them what to expect and often extolling the care they are getting. This fall, the University of Toledo Medical Center launched an internal “iCARE University” dedicated to training employees on improving patients’ experiences.
