Hospitals working harder to make Medicare patients
Patient surveys more important since Medicare began requiring hospitals
to report on satisfaction in 2007 - check your hospital's scores
By Jordan Rau, Kaiser Health News
10, 2015 - Lillie Robinson came to Rowan Medical Center for surgery on
her left foot. She expected to be in and out in a day, returning weeks
later for her surgeon to operate on the other foot. But that’s not how
things turned out.
“When I got here I found out he was doing both,” she said. “We didn’t
realize that until they started medicating me for the procedure.”
Robinson signed a consent form and the operation went fine, but she was
told she would be in the hospital far longer than she had expected.
“I wasn’t prepared for that,” she said.
Disappointing patients such as Robinson is a persistent problem for
Rowan, a hospital with some the lowest levels of patient satisfaction in
the country. In surveys sent to patients after they leave, Rowan’s
patients are less likely than those at most hospitals to say that they
always received help promptly and that their pain was controlled well.
Rowan’s patients say they would recommend the hospital far less often
than patients do elsewhere.
Feedback from patients such as Robinson matters to Rowan and to
hospitals across the country. Since Medicare began requiring hospitals
to collect information about patient satisfaction and report it to the
government in 2007, these
have grown in influence.
In April, the government will begin boiling down the patient feedback
five-star rating for
hospitals. Federal officials say they hope that will make it
easier for consumers to digest the information now available on
website. Hospitals say judging them on a one-to-five scale is
Nationally, the hospital industry has improved in all the areas the
surveys track, including clean and quiet their rooms are and how well
doctors and nurses communicate. But hundreds of hospitals have not made
headway in boosting their ratings, federal records show.
“For the most part, the organizations that are doing really wonderfully
now were doing well five years ago,” said Deirdre Mylod, an executive
for Press Ganey, a company that conducts the surveys for many hospitals.
“The high performers tend to continue to be the high performers and the
low performers tend to be low performers.”
Some hospitals have made great gains. The University of Missouri Health
System, for example, created a live simulation center at its medical
school in Columbia to help doctors learn to communicate better with
patients. The simulations use paid actors. Instead of having to diagnose
the patient, doctors must respond to nonmedical issues, such as a
feuding teenager and mother or a patient angry that he was not given
information about his condition quickly enough.
“My scenario was I was late to the appointment and the patient’s husband
was upset,” said Dr. Kristin Hahn-Cover, a physician at Missouri’s
University Hospital. In 2013, the most recent year that the government
has provided data for, 78 percent of patients at University Hospital
said doctors always communicated well, a 10 percentage point jump from
2007. Other scores rose even more.
At Virginia Hospital Center in Arlington, executives credit improvements
in patient satisfaction to their psychological screening methods in
hiring and rigorous job reviews. Potential nurses and other staff must
first pass a behavioral screening test and then be interviewed and
endorsed by some of the staffers with whom they would be working. In the
third element of the program, every six months, managers rate employee
performance as high, medium or low. Low performers are told to improve
or find work elsewhere.
“Those are the three most defining things we did as an organization,”
said Adrian Stanton, the hospital’s chief marketing officer. “Without
that, I can guarantee you we wouldn’t have had the successes.”
Nudging up scores has been a frustrating endeavor elsewhere, like at
Novant Health, a nonprofit hospital system that runs Rowan Medical
Center and 13 other hospitals in North Carolina, South Carolina and
Virginia. While some Novant hospitals have excellent patient reviews,
Rowan’s scores have remained stubbornly low since Novant took over the
hospital in 2008. The hospital is losing $29,000 this year because of
the low scores.
Last fall, Rowan’s president, Dari Caldwell, replaced the physician
group that ran the emergency room because the doctors had not reduced
wait times. ER waits are down to half an hour, a spokeswoman said.
Doctors and nurses also are being coached on their bedside manner, like
being advised not to stare at their computer when a patient is talking.
Rowan’s nurses now spend 70 percent of their time with patients,
swinging by every hour. Even the president makes rounds once a day. The
hospital has made lots of small improvements to provide a warmer
environment, such as putting white poster boards in each room where
nurses can list a few personal details about their patients.
“I can go in there and say ‘Oh, you have three dogs’ or ‘You have a
grandchild, that’s great, great,’” said Jennifer Payne, a nurse manager.
“And they can talk for hours about that.”
Payne said she pores over patient comments and surveys, passing around
the good ones and tackling complaints. “We’re very driven by what these
patients say,” she said. “Everything I do is based around how these
patients come back (in comments in the surveys) and say, ‘Hey is this
working’ or ‘This isn’t working.’”
Check Your Hospital's
survey former patients
to learn about the
quality of their stays.
information from them is
published by the U.S.
Centers for Medicare &
Medicaid Services, which
also uses the results
when setting Medicare
pay rates. Use this tool
to see how patients
rated your hospital on
11 topics and how it
compares with state and
national averages. These
scores reflect responses
from patients who were
January 2013 and
December 2013. They
include responses from
adult patients and are
not restricted to those
on Medicare. Scores
colored green indicate
that the hospital rated
better than both the
state and national
average; scores colored
red indicate the
hospital performed worse
Rowan executives fear scores may not be going up because patients still
harbor bad memories from previous hospitalizations.
“I was treated like a dog,” Carl Denham, 76, said about a stay two years
ago. He said the hospital was doing loud construction work that kept him
awake, and it took nurses all day to deliver an oxygen tank his doctor
Admitted again in Rowan in December, Denham said that visit was
different. “It is fantastic from what it used to be if you want my
opinion,” he said as he lay in his hospital bed a few days after he came
back. “I’ve been both ways and the way it is now, it is great. No
waiting and the doctors are all pleasant. I never thought I’d see it
like this.” He said he would give the hospital top marks.
His daughter Benicia said that in the last visit she had to nag the
nurses to get her dad his medication. This time, it has not been an
issue. “It’s like a totally different hospital,” she said. “I had to
say, ‘Did I come to Rowan Regional?’ ”
Despite the unexpected operation on both feet, Robinson also said nurses
have been attentive to her pain. “They do the best they can,” she said.
“At times it gets so bad I’m crying because it’s overwhelming to me.”
But “the best they can” is not good enough for Medicare. In determining
how much to pay hospitals, the government only gives credit when
patients says they “always” got the care they wanted during their stay,
such as their pain was “always” well-controlled. If a patient says that
level of care was “usually” provided, it does not count at all.
Likewise, the surveys ask patients to rank their stays on a scale of 0
to 10; Medicare only pays attention to how many patients award the
hospital a 9 or 10.
“Sometimes what we see and hear from our patients doesn’t show up on
their surveys,” Rowan’s president Caldwell said.
Another challenge for hospitals is that Medicare does not take into
account the inexact nature of these ratings, which can be based on as
few as 100 patients over a year. Medicare recommends a minimum of 300
surveys, but even those have imprecisions that Medicare does not
highlight when publishing ratings on Hospital Compare, or take into
account when determining financial bonuses or penalties.
In its hospitals with lower ratings, Novant is trying to replicate some
of its successes at its Medical Park Hospital in Winston-Salem, a
surgical center, which has
the best patient
satisfaction scores in the Novant system. Sean Keyser,
Novant’s vice president for patient experience, interviewed the staff to
figure out how it performed so well.
“The first thing they suggested was the relationship between the
physician and the nurses,” he said. “They tend to round more together;
they tend to huddle more together. It doesn’t matter how long we study
health care organizations, personal relationships that caregivers have
with each other translates into better relations with patients.”
Staff members from Medical Park now conduct the pre-surgical discussions
for patients at several bigger Novant hospitals. Those preparatory
talks, which take place a week or two before planned operations, give
nurses the chance to allay fears and make sure that patients have
realistic expectations of what will happen.
Dr. Scott Berger, a surgeon, said the smallness of the hospital—Medical
Park has only 22 beds, while Rowan has 268 — gives Medical Park an
advantage over other hospitals in pleasing patients. “We also think that
because we only do surgery here, that we’re really able to have kind of
a sharp edge, if you will, of focus on good outcomes and good patient
care,” he said. “And that really carries over to the nurses as well.
Because all day every day, that’s all they see, is the same kind of
surgical patients over and over again.”
Even patients who had not prepared to come to Medical Park are
impressed. George Stilphen, who was admitted for emergency colon cancer
surgery, said he planned to rate the hospital a 10.
“They said that they’d take great care of us,” he said as he recovered
from surgery in the hospital. “They were very soothing, comforting, they
weren’t condescending. It was a great experience.”
Michael Tomsic, a reporter for WFAE, contributed to this report.
You may be eligible for money damages if you owned or leased one of these VW, Porsche or Audi vehicles.
In the major scandal of 2015, Volkswagen cheated you and the world. They rigged diesel emission controls so you, nor regulators, would know how much pollution their cars were adding to our environment.
They were caught and have reserved $7.3 billion to help "make it right" with victims.
If you owned or leased one of these vehicles, contact us now.
Janicek Law attorneys are actively pursuing these cases against VW. Do Not Wait...