The Centers for Medicare & Medicaid Services' patient satisfaction rating system puts large urban hospitals at a distinct disadvantage compared to their smaller urban/suburban counterparts, according to research published in the Journal of Hospital Medicine.
CMS regards improving patient satisfaction scores as a major step in the transition from fee-for-service healthcare to a value-based model, and post-Affordable Care Act, scores are more heavily weighted in the formula the agency uses to determine reimbursements. Despite this, a recent report indicates overall patient satisfaction is nearing a 10-year low even as demand for services increases. The problem is even more pronounced in urban areas, which often have populations that contain large numbers of low-income patients and those who speak English as a second language.
Researchers, led by Randall Holcombe, M.D., chief medical officer for cancer at Mount Sinai Health System in New York City, studied survey data from 934,800 patients at 3,907 hospitals, and found that regardless of the organization's location, English as primary language and hospital size were major predictors of patient satisfaction. Overall, patients gave the lowest scores in densely populated regions such as the District of Columbia, California, New Jersey and Maryland. Conversely, more sparsely populated areas such as South Dakota, Maine, Vermont and Louisiana had higher scores, according to Holcombe.
"Across the country, large hospital size and non-English as a primary language predicted poor patient satisfaction scores while white race and higher education level predicted better scores," co-author Daniel McFarland, a clinical fellow at Mount Sinai's Icahn School of Medicine, said in the study announcement. "Other demographic factors were also important but these four were the most significant."
Much like patient satisfaction scores, racial disparities are a major priority for the healthcare industry. A study published in JAMA Surgery last year found that unequal hospital access across racial lines accounted for more than half of these disparities, FierceHealthcare previously reported.