Patient satisfaction means bonuses or penalties

Affordable Care Act rewards hospitals according to client surveys. Safety-net facilities serving poor are rated lower.

Posted: July 15, 2013

Patients at Cancer Treatment Centers of America in Northeast Philadelphia get chauffeured trips to the hospital, often in a limousine. They were recently treated to a performance by a vintage soul group, the Pointer Sisters, and are regularly welcomed with live piano music, fresh organic fare in the cafeteria, and receptionists befitting a classy hotel.

These perks are part of the for-profit hospital's strategy to keep patients happy and avoid government penalties. In fact, the center enjoys patient satisfaction numbers among the best of any hospital in the region.

"I'd rate it at least a 10," said Jay Watson, 59, waiting for test results beside his wife Barbara, 58. They have traveled back and forth from West Virginia to CTCA Eastern Regional Medical Center since October for his oral cancer care.

What made the biggest impression? "I can't think of a time when our radiologist didn't sit down and pray with us," said Barbara.

Experts say patient satisfaction surveys are important and can be linked to good care, but are no guarantee of it. Still, the center's results may be higher in part because it relies mainly on payments from commercial insurers and doesn't accept poor patients on Medicaid, which tends to drag down surveys of other hospitals.

Bucks County Specialty Hospital in Bensalem, an orthopedic facility owned by the Rothman Institute, came out highest in the region in key federal surveys. It also does not accept Medicaid, according to the hospital's reports to the Pennsylvania Health Care Cost Containment Council.

"We talk about patient satisfaction in every single meeting, every committee," said Kelly Doyle, Rothman's chief executive officer. "When we have a [score of] 94, we look at that and ask how do we get that up to a 99? If we get an outlier, if the patient left any information as far as contacting them, we call the patient to discuss what went wrong."

Keeping hospital patients happy is more important than ever. A provision in the Affordable Care Act rewards hospitals that keep their patients satisfied and follow procedures that promote good care, and penalizes those that don't.

This fiscal year, hospitals gained or lost as much as 1 percent of their Medicare reimbursements on combined quality and survey measures. Within four years, the government will double potential withholdings to 2 percent.

Whether the program treats hospitals fairly is unclear. A 2012 study in the Archives of Internal Medicine found that safety-net hospitals, those that serve high proportions of poor patients, were rated lower on nearly all measures of satisfaction by their patients.

"That safety-net hospitals get more penalties doesn't necessarily mean that it's a bad policy," said study author Ashish Jha, a Harvard University public health professor. "It depends on why they are getting worse penalties. Are they providing lower quality of care? If so, then the penalties aren't as much of a problem. Or is there something else going on?"

In the Philadelphia area, the bottom 10 hospitals, measured by overall patient satisfaction, got five times more of their patient revenue from Medicaid, on average, than the top 10, according to 2012 financial information sent by law to the Pennsylvania Health Care Cost Containment Council. (Equivalent statistics are not easily available for New Jersey.)

At the CTCA location in the city's Crescentville section, by contrast, about 85 percent of patients are covered by commercial insurance - the best payers - with the rest on Medicare, said spokeswoman Julia Scherer.

Since the Affordable Care Act changes began in October 2012, the cancer center has earned an additional 0.06 percent on its Medicare payments. For the hospital, which has about $400 million in annual revenues, the bonus will come to about $127,800 for the fiscal year that ends Sept. 30. Scherer said the low bonus - nowhere near the potential 1 percent - is because the government's scoring formula rates hospitals for treating some patients that the cancer center rarely sees, such as those with cardiac problems.

Rothman got the biggest bonus in the Philadelphia area, earning an additional 0.67 percent on Medicare reimbursements.

Doyle, its CEO, estimated that Rothman, with $29 million in annual revenues, would make an additional $20,000 this fiscal year.

Eighteen hospitals in the area have been losing money under the policy, including Lourdes Medical Center of Burlington County, where 10 percent of patient revenues came from Medicaid and 30 percent from Medicare in 2011, tax returns show. The hospital has been penalized 0.47 percent on Medicare payments this year, due in large part to patient dissatisfaction, with scores ranking among the lowest in the region.

Almost a third of surveyed patients there said that staff sometimes or never explained medicine usage before they received prescriptions, and about as many said they sometimes or never got the information before being discharged.

"Most of our problems have revolved around communication," said Alan Pope, chief medical officer at Lourdes Health System, which also includes Our Lady of Lourdes Medical Center in Camden. That one scored better but not good.

Pope said the Burlington County hospital had hired a new patient experience manager, required nurses to make rounds hourly, started a physician communication task force, and begun a policy making sure every patient receives a call within three days of discharge.

"We want to show that we are listening better and that we're better at taking better care of the patient's needs," Pope said.

Other losers during the current penalty period were Nazareth Hospital in Northeast Philadelphia, where almost a third of surveyed patients said staff sometimes or never explained medicines before giving them out; Lower Bucks Hospital, where one of six patients said their rooms were either sometimes or never quiet; and St. Joseph's Hospital in North Philadelphia, where a quarter said they would definitely not recommend it. P { margin-bottom: 0.08in; }

At St. Joe's, which has the highest percentage of Medicaid patients in the region, a committee has been meeting daily since the scores came out. "We just have to strive to do better," CEO Catherine Kutzler said.

The surveys are sent to Medicare patients after they leave the hospital. Several hundred patients from each hospital are asked 27 questions, including eight that are used to assess penalties or bonuses. Among those: Score how clearly doctors and nurses communicated, how well their pain was controlled, how messy and loud their rooms were, and how they would rate the hospital overall.

The surveys, which have been controversial because they are based on patient opinions rather than medical outcomes, are increasingly being accepted as valuable indicators.

Two articles published this year in medical journals, BMJ Open and New England Journal of Medicine, reported findings that the patient experience and quality of care are linked.

John McNeil, chief executive officer of CTCA's Eastern Regional Medical Center, played down his hospital's excellent rating in an interview.

"It's never been about a score. It's about the patient's experience and outcomes," McNeil said.

Still, four of the 32 pages in his hospital's annual report are devoted to surveys of patient satisfaction.


Contact Curtis Skinner at 215-854-2930 or cskinner@philly.com, or follow him on Twitter @CurtisOrion.

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