By Chuck Lauer
I just read an interesting article in the Wall Street Journal titled, “U.S. Ties Hospital Payments to Making Patients Happy."
It described how Grady Memorial Hospital in Atlanta is responding to the new Hospital Inpatient Value-Based Purchasing (VBP) Program, which ties a portion of Medicare payments to performance on the government’s patient satisfaction survey, known as HCAHPS.
Grady is doing a bunch of things, from teaching doctors not to interrupt patients while they are speaking to providing nurses cell phones so patients can reach them instantly. It has added ESPN to in-room TVs and upgraded food service menus with choices like wild salmon. In an industry that isn’t used to change, some of these changes aren’t sitting well with some staffers at Grady and other hospitals across the nation.
The reason for most of the activity is simple: money.
Nearly $1 billion in payments to hospitals over the next year is at stake under VBP. If a hospital has high satisfaction scores, it will get a bonus payment. But if it has low scores, it loses money.
John M. Haupert, Grady Memorial’s CEO, claims that all his peers are totally preoccupied with making sure they abide with all the new rules in order to make sure they don't end up losing money. The 27-question HCAHPS survey, which has been around for a few years, has taken on more importance.
Many medical professionals are upset with the questionnaire and say it’s unfair. Some even think they are being discriminated against because their hospitals are old or their emergency rooms are overcrowded. Of course, one could ask why hospitals won’t do more to make their ERs less crowded through better patient flow, as a number of facilities have done. In some cases hospital ERs are now profit centers!
It’s amazing to me that for many healthcare people HCAHPS is a surprise. The federal government has surveyed patients on their hospital experience since 2006, using the same standard questionnaire. Since 2008, hospitals have had 2 percent of payment at risk if they failed to report survey results. Starting Oct. 1, however, scores for about 3,500 of the nation's 5,000 hospitals are used to calculate new payment rates.
The overall VBP scores reflect both HCAHPS results and how well hospitals follow a dozen procedural metrics for treating such things as heart ailments and pneumonia. For example, a hospital can be marked down if it doesn’t immediately give patients medication during a heart attack. So, the rules are tough and complicated.
HCAHPS asks questions such as, “How often did doctors treat you with courtesy and respect?" and “How often were your room and bathroom kept clean?" Then the survey asks patients to rate their stay on a scale of 0 to 10.
This has led to some disgruntled caregivers. For instance, the Journal quotes Dr. Rhonda Scott, Grady's chief nursing officer, as saying: “You go to Disney for a great experience. Then you go to Ruth's Chris for a great dining experience. Do you think it is a great experience when I tell you that you have stage-four cancer and you may be dead in three months?"
Some hospitals say that certain questions on the survey are at odds with other goals. For instance HCAHPS asks, "How often did the hospital staff do everything they could to help you with your pain?" Executives say that conflicts with an effort to curb abuse of powerful pain drugs. Dr. Patrick Conway, chief medical officer at the Centers for Medicare and Medicaid Services, said the agency may consider whether that question needs adjusting.
There's still more changes taking place at Grady Memorial. Doctors are being asked to stop talking to patients while standing over them in bed. Instead, they are encouraged to pull up a chair so that they are at eye level. Furthermore, Scott now requires nurses to call patients after they are discharged to remind them about follow-up appointments and to answer medication questions. For an industry that for years has not done a very good job of treating patients as customers, the world is changing and I believe for the better. After all, both the press and healthcare executives have told us repeatedly that the industry has become a very competitive business. So, like other industries that have to satisfy their customers to stay in business, maybe the healthcare industry can catch up and begin to realize who its real customers are: patients.
The culture change is going to take some time to sink in, but what’s going on today is a step in the right direction and long overdue. Many people I talk to in healthcare have already internalized the notion that patients want to be something more than an interruption of the care provider’s busy day.
Let’s hope that healthcare will start the second decade of the 21st century as a real business and not a cottage industry.