Peaceful artwork at Providence Park Hospital in Novi, Mich., is frameless to better absorb hallway noise, part of an effort to boost patient satisfaction.(Photo: Regina H. Boone, Detroit Free Press)
At Providence Park Hospital in Novi, Mich., the artwork hanging on the walls isn't covered with glass, in an effort to absorb noise.
air-blowing vests keep patients warm pre-surgery. Private rooms are the
norm. Staffers regularly check in with patients to anticipate their
toilet and showering needs to cut down on call-light usage. Patients are
given clear discharge instructions. Cleaning is no longer done at
night. Patients are taught the difference between "pain-free" and
The reason for these changes at Providence Park
and similar ones at other hospitals across the country is to ensure
high scores on patient satisfaction surveys, the results of which will
affect Medicare reimbursement rates, starting next year.
At issue are millions of dollars annually, all the more significant
as the industry sees so many other dollars slipping away. In fiscal year
2013, for example, the pot is $964 million, according to the federal
government's Centers for Medicare & Medicaid Services.
such as free lattes and valet parking are not new to hospitals. They
began offering them years ago in a high-stakes fight to lure patients.
However, what hospitals are doing now is, for the most part, tailored to
the survey questions they know patients will be asked.
Noise is a
big topic. Providence Park has reduced the number of loud carts pushed
along its corridors. Instead, patients get "quiet kits" containing ear
plugs and relaxation-inducing lavender lotion.
Another survey topic is staff attention.
and whistles make it a nicer environment for patents, but if you're not
addressing holistic, spiritual care, they're not going to rate it
well," said Dr. Linda Dubay, St. John Providence Health System's chief
quality officer. "We take these things and focus it up from there in
addressing the patients' needs."
The Hospital Consumer Assessment
of Healthcare Providers and Systems, or HCAHPS (pronounced H-caps) -
first instituted in 2006 as a 27-question survey for discharged patients
- was initially designed to be a comparison tool people could use to
choose a hospital. Under the Affordable Care Act, it morphed into a
dollars-loaded query in October, the start of the 2013 fiscal year.
In January, another five questions will be added.
are at risk of losing 1% of their payouts this year if they don't do
well on the surveys. That will jump to 2% by fiscal year 2017.
have to submit a minimum of 100 surveys. To prevent them from
cherry-picking the most favorable replies, the Centers for Medicare
& Medicaid Services will do quarterly random audits of data.
the past, hospitals and other providers were paid almost solely based
on how much work they did - not on how well they did for patients," the
Centers for Medicare & Medicaid Services said in an e-mail. "Since
the ACA, however, we have a number of programs in place ... that reward
hospitals and doctors based on the quality of care they deliver for
Among the topics in the surveys are:
• Nursing and doctor care (Did they treat you with courtesy and respect and explain things to you clearly?).
• The hospital environment (Was your room clean and quiet).
• Pain (Was your pain well-controlled).
• The discharge process.
Botsford Hospital, changes include nurses talking to patients hourly to
inquire if they need to use the bathroom and to ensure all personal
items such as water, the call button and the phone are within arm's
reach; audio-video relaxation system in patient rooms, and detailed
"Passport to Care" discharge packets.
"It's important to score
that well, because that reflects we're doing the right thing for our
patients," said Kim Guesman, Botsford's director of nursing services.
"We're not doing it just for the money. We're doing it because it's the
right thing to do."
But others in southeastern Michigan, like St.
Joseph Mercy and Beaumont health systems and Sinai-Grace Hospital, said
they aren't motivated by the Medicare payments to improve patient care.
don't frankly respond to changes in reimbursement or other national
surveys and comparisons," said Tom Brisse, Beaumont's executive vice
president of operations. "We've been working for decades to improve
He said that less than $3 million is at stake, a tiny portion of the hospital's $2.2 billion operation.
Balkrishnan, a University of Michigan associate professor of pharmacy
and public health who has researched patient satisfaction surveys, said
this regulatory move is a positive one, citing among other reasons the
importance of patient empowerment.
"The problem is America is a
free-market economy," he said. "We need to give patients a way to speak
on what they think about health care, what works for them, how health
care professionals work for them, because those factors go into
determining whether treatments are successful."
Zlati Meyer, Detroit Free Press