Part Of Hospitals' Medicare Payments To Be Tied To Patient Satisfaction

On top of the regular duties associated with saving lives, hospitals are now directing efforts toward a less-quantifiable goal: ensuring customer satisfaction.

That's because one aspect of the federal Affordable Care Act will take effect in January: Medicare payments will go up or down, depending in part on how happy patients are with their care.

The survey, titled the Hospital Consumer Assessment Healthcare Providers and Systems (HCAHPS) Survey, asks patients 27 questions about their hospital experience. The questions include how carefully nurses listen, how long patients had to wait after calling for help, hospital cleanliness, and the effectiveness of pain-relief measures.

The federal Centers for Medicare & Medicaid Services (CMS) will calculate a portion of payments to hospitals based on the survey's scores. According to the CMS, the survey program began Oct. 1, although the survey has been administered since 2006. Payment adjustments based on results will begin to hit hospital budgets in January.

Hospitals expect to receive individual payment reports late this month, with publicly reported scoring information to be released by the government in April 2013. Hospitals received estimated payment reports in August based on preliminary survey scores.

But some area hospitals already know how their Medicare payments — which account for a sizeable portion of their revenue — will be affected by their results. And they've already implemented new customer-service practices to improve future funding levels.

"We're continually changing processes and looking to bump up our scores because we don't want to be left lagging behind the pack," said Kathleen Davis, vice president of quality and patient safety at Harrington HealthCare.

According to preliminary scores released by the U.S. Department of Health & Human Services (HHS), Southbridge-based Harrington Memorial Hospital's results hover around the state and national averages. It surpassed state averages in a handful of categories, but lagged a couple of percentage points in a few.

Tom Sullivan, chief financial officer at Harrington, said the hospital will lose about $170,000 in Medicare funding in fiscal 2013 based on the results. It's not a lot of money, Sullivan said, but the hospital has adjusted spending as a result.

"Anytime you lose money, it hurts," Sullivan said.

To shore up future funding, Harrington is working on bringing the noise level down at night, an area where hospitals in Massachusetts and beyond struggle, in general. Administrators are also working with the nursing staff to improve communication with patients, staff responsiveness, and pain-control measures, Davis said.

"We've seen improvement, but is it high enough according to the national standards? I'm not sure yet," Davis said.

Davis, however, thinks the survey is a valuable tool for improvement.

Administrators at Milford Regional Medical Center echoed that sentiment.

Annette Roberts, director of quality at Milford Regional, said that while clinical outcomes are a larger factor in determining the hospital's Medicare funding, patient satisfaction is crucial.

Milford Regional ranked at or above state averages in all categories, according to the HHS preliminary scores. But like Harrington, the hospital is looking for ways to improve. An area of particular focus was patient meals, according to hospital president Edward J. Kelly. To improve scores, the hospital implemented a new system that allows patients to call for meals at any time.

"We want to get better, and we want to use this (survey) as a tool," Kelly said.

Adjustments In Leominster

In Leominster, HealthAlliance Hospital will experience neutral Medicare funding in fiscal 2013 as a result of its HCAHPS survey results, said Lisa Colombo, vice president of patient care services. But just because the hospital budget won't be impacted doesn't mean it's not acting on preliminary survey results.

HealthAlliance, which scored above average in some categories and fell short of it in a few, is also implementing a new strategy for keeping the hospital quiet at night. And the hospital plans renovations to some dated buildings to improve patients' perception of cleanliness.

Hospital administrators have been using patient surveys for years for their own purposes.

The difference, aside from their being mandatory, is that the HCAPHS survey is uniform across all hospitals, and administered at random by an outside company according to Davis, the director of quality at Harrington.

Patient satisfaction surveys are subjective, of course. But Georges Benjamin, executive director of the Washington D.C.-based American Public Health Association, said they can also influence patient outcomes.

"We do customer satisfaction surveys in every industry," Benjamin said. "Health care ought not be different."

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