Patient experience: The wild card in reimbursements

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 Karen Cheung-Larivee

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A few years ago, I accompanied my friend who had shoulder surgery at a premier teaching hospital in Boston. My friend, who was also a medical researcher and had previous surgeries, knew that she becomes extremely combative under anesthesia and other drugs. She warned her providers before the surgery and explained that she was uncomfortable with too many people in the room.

The day of the surgery, the teaching hospital did what it does best--teach--and brought in a swarm of interns to insert the nerve-block. Out of anger, she may have said something along the lines of: "No way, Doogie. Get me a real doctor." She went under mad and woke up even madder. Even though the surgery was a clinical success and her shoulder healed just fine, her experience was far from positive.

Does her experience reflect poorly on the hospital and its quality of care?

In short, yes.

In just a few weeks, patient satisfaction--for better or worse--will affect hospital reimbursements. Incidents like the one my friend had could impact the 44 percent of hospitals that participate in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. Under the Value-Based Purchasing program in October--arguably the biggest quality improvement initiative to ever hit Medicare hospitals--HCAHPS quality measures will be linked to IPPS hospitals' payment in which patient satisfaction will determine 30 percent of performance scores for incentive payments, while clinical measures make up the other 70 percent.

The survey, which asks patients to rate their hospital experience, includes items on communication with nurses and doctors, staff responsiveness, pain management, communication about medicines, discharge information, hospital cleanliness and quietness and a global measure on overall hospital experience.

In my friend's case, she would have given a thumbs-down on communication, pain management and overall experience.

Critics of the patient experience measure argue that it's all subjective. But regardless of the debate, hospitals will low, or even mediocre, scores will suffer--and it'll be online for the public to see.

"Medicare is very clear about this. Average performers won't break even," Edward Murphy, past president and CEO of Carilion Clinic in Blacksburg, Va., and chair of the board at hospitalist group Sound Physicians, previously said at the American College of Health Executives' (ACHE) annual congress in Chicago.

So take a look to your right and a look to your left. If you're not far better than your counterparts, you will be hit in the pocketbook. - Karen (@FierceHealth)

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