Local hospital administrators are focusing on improving everything from catering menus to patient and staff communication since Medicare last year began paying them partly based on patient satisfaction scores under the health care overhaul.
While Medicare has been publishing patient satisfaction scores since 2008, it wasn’t until last year that the system began withholding 1 percent of its payments to hospitals. In the next few years, the federal government plans to double its withholding to 2 percent. That money goes into a pool and is distributed as bonuses to hospitals that score above the national average.
“It’s put patient satisfaction at the forefront,” said Derick Ziegler, administrator and CEO of Baptist Memorial Hospital-Memphis. “It has put more money at risk, and now hospitals have to earn those dollars.”
Patient satisfaction scores determine about 30 percent of the bonuses, while the rest of the bonus is distributed based on meeting certain clinical measures.
While the push began with Medicare funding, private businesses and health insurance companies are now encouraging patient satisfaction metrics on everything from how quickly physicians return phone calls to how long patients wait in a physician’s office waiting area.
It’s all part of an overall move away from the old fee for service model and toward a new model that ties reimbursement to overall quality and patient satisfaction, also known as value-based purchasing.
Patients are given a 32-question survey that asks everything from whether their doctor listened to their questions to whether their room was quiet at night. Patients can go online to compare hospitals online through a site called Hospital Care that is run by Medicare: www.medicare.gov/hospitalcompare/compare.html.
Critics have said the program is unfair to safety-net hospitals like The Regional Medical Center at Memphis, which treat high proportions of low-income patients. Nationally, safety-net hospitals were rated lower on nearly all measures of patient satisfaction than their counterparts.
That’s also true on most measures locally. When asked whether they would definitely recommend the hospital to others; 68 percent of patients treated at The MED said yes, compared with 79 percent at Baptist Memorial Hospital-Memphis, 77 percent at all Methodist Le Bonheur Healthcare hospitals and 71 percent at Saint Francis Hospital.
While some hospitals across the country have rolled out measures like acupuncture, gourmet food, massage and transportation services to bolster patient satisfaction, most local hospitals are focusing on improving communication and other evidence-based practices.
Ziegler said Baptist Memorial has hired a consulting firm to implement techniques like AIDET, a communication framework for Baptist’s staff to communicate with patients and families more effectively.
The technique is a proven way to communicate with people who are going through a stressful event. Staff members acknowledge the patient, introduce themselves and explain what procedure they will be performing, explain the duration of the procedure work to ease waiting times, explain how procedures work and communicate with the patient, and thank patients and other staff members for patronage, help and assistance.
“This is a big hospital; I knew we weren’t going to turn the ship around overnight,” Ziegler said. “This was really about focusing our efforts on our patients’ experiences.”
While the data has a considerable lag – the first hospital care scores for patients are based on data collected between Oct. 1, 2011, to Sept. 30, 2012 – Ziegler said he’s already noticing many of the patient thank you notes have a very different context. While older thank you notes may have commended a certain nurse or staff member, now it’s not unusual to receive a letter thanking Zieger for every aspect of their stay at the hospital.
Baptist also has started gathering a patient’s care team daily to go over everything from the patient’s anticipated discharge date to making sure the patient and his or her family have all the information they need for that day.
Nurses also change shifts in front of patients and their families and have the opportunity to make sure they have all of the information they need to know about caring for the patient before the other nurse leaves for the day. The family also has the opportunity to contribute to the conversation and ask questions.
Michelle Collis, vice president of patient and family centered care at Methodist Le Bonheur Healthcare, said Methodist also has focused on improving patient and staff communication.
“One of the most important principles is being able to share information in an unbiased and useful way,” she explained. “We do a great job of talking and we have a lot of information to share, but we need to do a better job of listening.”
Methodist has about 160 volunteers who help listen to patients and families and help answer questions.
Like at Baptist, nurses change shifts in front of patients and physicians, nurses and staff are trained to improve communication both at a patient’s beside and after discharge.
That means everything from basic changes like making sure the white boards in hospital rooms are updated with patient-friendly language instead of jargon, and more complicated systematic changes like making sure nurses stop by a patient’s room on a regular basis to communicate with the patient and his or her family – a practice known as purposeful and intentional rounding.
“Being hospitalized is a central event in most patient’s lives, and we do a tremendous amount to sensitize our staff to understand that,” Collis said. “It all goes back to the culture change and really listening to patients and their families.”