Patients have spoken and—Surprise!—they prefer suburban hospitals to inner-city or big teaching hospitals.

That means a little extra Medicare money will likely flow to suburban hospitals in the Indianapolis area. But hospitals in the core of Indianapolis, and hospitals that do significant amounts of teaching medical students, may take a hit.

That’s the upshot of data released July 19 by the federal Medicare program on how patients rated their hospital experiences. Beginning in October, Medicare will reduce all hospitals’ payments 1 percent, then redistribute the savings to hospitals that do best on quality and patient-satisfaction measures.

Quality will count the most in that calculation: 70 percent. But patient-satisfaction surveys will make up the other 30 percent. Hospitals must exceed the national average satisfaction score among all hospitals in order to earn points toward a bonus payment.

Medicare quizzed seniors in 10 categories, and used a tough grading scale. It counted only the number of patients who said hospital staff “always” communicated well, immediately responded to requests for help, kept the patients’ pain controlled, explained medications before giving them, provided a clean bathroom and a quiet room at night, and gave patients instructions for managing their recovery at home.

Medicare also asked patients whether they would “definitely recommend” the hospital. And it asked patients to rate the hospital on a scale of one to 10—and only counted the patients who awarded a score of nine or 10.

“These are hard scores to improve, and I think that’s why hospitals get frustrated,” Dale Shaller, a Minnesota health care researcher who oversees the national patient survey database for the federal government, told the Washington Post and Kaiser Health News last year.

Indianapolis-area hospitals are certainly trying to improve their standing with patients, even putting their staffs through the kind of standardized training more common among hotel and restaurant chains.

Clearly, however, a hospital’s location—which often determines the severity of the illnesses and complexity of procedures its patients have—affects its patient satisfaction scores.

For example, St. Vincent Indianapolis Hospital on West 86th Street scored better than the national average in just three out of 10 categories on which Medicare patients were surveyed. But St. Vincent’s Carmel Hospital and its Heart Center on North Meridian Street both exceeded the national average in nine of the 10 categories.

Likewise, Indiana University Health’s three downtown hospitals—Methodist, University and Riley Hospital for Children—exceeded the national average in just three out of 10 categories, although Medicare said those results might be skewed by discrepancies in its data-collection process.

But IU Health’s suburban hospitals did a bit better: IU North Hospital in Carmel exceeded the national average in five out of 10 categories, and IU West in Avon exceeded it in six of 10.

Of the four major private hospital systems in the Indianapolis area, Community Health Network struggled the most. Its Community North Hospital in the Castleton area exceeded national averages in three categories, while its South hospital near Greenwood and its Westview hospital along West 38th Street exceeded national norms in just two categories.

Community’s East hospital did not exceed the national average in any category. Community’s Indiana Heart Hospital exceeded national norms in six of 10 categories.

Franciscan St. Francis Health exceeded national averages in six and eight categories, respectively, at its Indianapolis hospital along Interstate 465 and its newer Mooresville campus. Its Beech Grove campus, which closed earlier this year, exceeded national norms in just two categories.

The highest-scoring hospital in Marion County was the Indiana Orthopaedic Hospital, which exceeded national averages in all 10 categories.

County-owned hospitals posted mixed performances, ranging from a perfect 10-for-10 performance by Major Hospital in Shelbyville to Wishard Memorial Hospital in downtown Indianapolis, which exceeded national norms in three of 10 categories.