Federal survey of patients puts hospitals to the test: Satisfaction questionnaire ranks criteria ranging from room cleanliness to communication skills of providers

April 14, 2008

New patient satisfaction scores compiled by the federal government and posted online give consumers more feedback than ever regarding the care hospitals provide. The usefulness of that information is up for debate.

On its Hospital Compare Web site, the Centers for Medicare & Medicaid Services tracks technical measures that show how often hospitals provide certain types of care that is recommended for patients treated for various conditions-heart attacks or pneumonia, for instance.

Starting late last month, the agency began including additional data gleaned from patient surveys conducted from October 2006 to June 2007. The new information is easier to understand and covers much more basic care.

Questions from the survey, which was used to evaluate more than 2,500 hospitals nationwide, include:

Did staff adequately explain the medicines they were about to administer?

How often were the room and bathroom cleaned?

Was the area around the room quiet?

Were patients told how to continue recovery at home?

Most medical providers survey patients, but the means and questions often vary. The new questionnaire is more transparent and consistent, permitting hospitals to be judged on the same criteria. Health care experts favor the changes, citing the survey as an example of increased uniformity within the sector.

"I think the health care industry has been somewhat reluctant to embrace these types of Web sites-not out of any concern about their quality, but out of concern about whether the measurements are valid," said Bill Thompson, managing partner of Hall Render Killian Heath & Lyman, an Indianapolis law firm that specializes in health care.

The government's Web site, www.hospitalcompare.hhs.gov, lets consumers compare up to three hospitals at a time. The data was collected by hospitals from a random sample of Medicare patients from October 2006 to June 2007 within 48 hours to six weeks after they were discharged.

Results for the major Marion County hospitals are mixed. Among those operated by Clarian Health, Community Health Network, St. Francis Hospital and Health Centers, St. Vincent Health and Wishard Health Services, patient satisfaction varied widely depending on the category.

For example, only slightly more than half the patients surveyed at St. Vincent's flagship hospital on 86th Street, 58 percent, thought the rooms were always quiet at night. Yet, the figure was high enough to lead all competitors in that category. Both the state and national average was 54 percent.

The hospitals fared much better, however, regarding whether their doctors communicated well. Eighty percent of patients at St. Francis' Indianapolis campus believed they did. No other local hospital scored below 73 percent. The state average was 81 percent; the national was 79 percent.

St. Francis also led the pack in the category of how often nurses communicated well, tallying 77 percent. The others mustered at least 68 percent. By comparison, hospitals averaged 76 percent statewide and 73 percent nationally on that question.

'Apples to apples'

Clarian's hospitals-Methodist Hospital, Indiana University Hospital and Riley Hospital for Children-scored lower than rivals in several instances.

Dr. Sam Flowers, Clarian's senior vice president of medical quality, attributed the results to a clientele that, in most cases, is very ill. The extremely high acuity and anxiety rates may skew the results, he said.

"It may not always be apples to apples to compare downtown Clarian to a suburban facility," he said, "but I still think it is somewhat useful."

Yet, metropolitan Indianapolis as a whole is one of the top regions for patient care in the country, according to a separate study from South Bend-based Press Ganey Associates Inc.

The city ranked fourth in the survey of nearly 3 million patients treated at roughly 2,000 hospitals last year. Only Wichita, Kan.; Columbia, S.C.; and Oklahoma City fared better.

The highly competitive health care market here likely led to the city's stellar showing, said Keith Jewell, senior vice president and chief operating officer for the St. Francis hospital system.

He welcomed the government's new survey, noting consumers often are more educated about their automobiles than their health care providers.

"With all the recent trends in health care, from competition to transparency to federal mandates," he said, "this is the federal government's attempt to put more power in the hands of consumers."

Even more transparency

But are the public, and particularly seniors, even aware the information exists? And, if so, can they decipher it? Dr. Glenn Bingle, chief medical officer at Community Hospitals, is uncertain.

"Many of the Medicare patients are over 65 and, personally, I'm nearing that age, and I'm finding it difficult to use," he said. "There are a lot of measures and there is a lot of variability."

With the addition of the 10 new patientsatisfaction measures, the Hospital Compare site now provides information on 26 topics.

CMS, an agency of the U.S. Department of Health and Human Services, introduced the patient satisfaction scores March 31 by issuing a press release picked up by national media outlets. Attention given to the survey might help steer consumers to the site, Bingle said.

Even so, unlike Medicare, private insurance plans often stipulate where consumers receive treatment. Health care experts agree, though, that the patient-satisfaction survey is a positive step toward achieving total transparency.

Pricing for certain procedures also is available, and experts think full pricing enabling consumers to comparison shop ultimately will follow.

In related news, a consortium of competing interests that includes insurers, employers, patient groups and physician organizations, unveiled April 2 the first nationwide effort to standardize doctor-rating programs.

Likewise, the initiative aims to infuse greater transparency and consistency into performance measures, but for physicians rather than hospitals. Still, the vast majority of patients select their doctor based on personal recommendations rather than on data, Bingle at Community Hospitals said.

For the strides that have been made, they represent just the beginning of a long-term process, said Dr. Jon Rahman, chief medical officer of St. Vincent Health.

"For all of us," he said, "this is kind of like ground zero."
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