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Unhappy Patients = Lower Reimbursement for Hospitals

The Value-based Purchasing Program was mandated in the 2010 Healthcare Reform Law. Medicare’s transition to this program will alter reimbursements to hospitals based on the quality of care provided to patients and patient satisfaction scores.  Medicare will cut 1 percent payments to hospitals and set that money aside in a bonus pool. Hospitals performing better than average on a variety of measurements, or improve their scores from the previous year, would earn bonus payments, totaling $850 million in the first year. The bonus pool would increase to 2 percent of Medicare payments in October 2016. 

Seventy percent of the bonuses will be based on how often hospitals follow guidelines on 12 clinical care measures. These include giving anti-clotting medication to heart attack patients within 30 minutes of arrival in the hospital; providing antibiotics to surgery patients just before an operation; and taking steps to avoid blood clots in patients who undergo surgery.  Thirty percent of the bonus will be determined by how patients rate hospitals on their hospitalization experiences. Medicare will use hospital-conducted surveys that ask patients about how nurses and doctors communicated, how clean their rooms and bathrooms were and how well their pain was controlled, were they given proper discharge instructions, etc. 

An analysis provided by Kaiser Health News shows that the unhappiest patients are in the Northeast and California compared to patients in the South and Midwest.  The reason why patients in the Northeast are unhappy….they have high expectations, they are less polite, and grumpy, according to analysts.  Hospitals are scrambling to provide amenities to patients and get good satisfaction scores to maximize their reimbursement.  Patients do not appreciate long waits in the emergency rooms, crowded elevators, and expect prompt attention when they arrive in their doctors’ offices.  I personally know a patient who had a fairly good stay in the hospital and was ready to give good satisfaction scores until the day of her discharge when her nursing attendant wasn’t very polite!  So, unhappy patients will directly affect hospital reimbursement in the future and hospitals are doing everything they can to boost those scores.  Renovations, additions to existing buildings, and new buildings definitely boost patient satisfaction even if the care provided is the same. 

Ratings can affect hospitals that cater to high-risk cases.  The longer the patient is hospitalized, the lower the satisfaction score the hospital gets, and depressed patients tend to give poor satisfaction scores.  Some hospitals have emergency room representatives talking to patients to inform them of their wait period, and others have a fast-track for patients arriving with routine problems like fever, minor injuries, etc.  In the children’s wards parents are provided food and snacks so that they can stay with their children (and also in the hope they will give a high satisfaction score on discharge!).

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Posted by on November 11, 2011 in General, Healthcare

 

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Low-performing hospitals care for greater numbers of elderly minority patients

A recent study,  Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients,  published in Health Affairs reported some previously unknown statistics that could have serious implications for Medicare‘s Value-Based Purchasing Program.   In the Commonwealth Fund supported study, the Harvard researchers led by Ashish K. Jha found that low-performing hospitals with high costs have double the proportion of elderly black patients compared to high-quality, low-cost hospitals. Similar disparities were also found for elderly Hispanic and Medicaid patients.

The researchers report that the lower-performing hospitals are the typical small public or for-profit institutions in the South, while the higher-performing facilities are mostly nonprofit institutions in the Northeast.  According to the authors of the study “The fact that the worst hospitals have more than twice the proportion of elderly black patients than the best hospitals is both startling and unknown.”

Hospital data was drawn from different sources including Hospital Compare, Medicare, the American Hospital Association, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Process measures were used to assign quality of care scores for acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications. 

Because the Affordable Care Act authorizes Medicare to give out higher payments to hospitals that achieve better performance while cutting reimbursements for those hospitals that fail to perform better, hospitals that can simultaneously provide high-quality care and manage their costs well are likely to come out ahead under health reform, the authors say.  Financial penalties  incurred by lower-performing hospitals may inadvertently worsen existing disparities in health care unless these hospitals improve on quality and cost of care.

 
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Posted by on October 9, 2011 in General, Healthcare

 

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