Medicolegal Issues

Are Patients Satisfied?


Have you seen what your discharged patients are saying about your hospital?

Now that patient satisfaction data is public, you can rest assured others are looking at how your facility stacks up against neighboring hospitals on doctor communication, pain management, and more.

As of late March, patient satisfaction information is available on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare consumer Web site (­ This allows for a new level of transparency about the quality of care hospitals provide.

“This is an opportunity,” says Mark V. Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“Hospitalists ought to look up the information on their hospitals and, if they’re not doing well, go to their administrators and say they want to help bring those standings up.”

Satisfaction Defined

How to Use Hospital Compare

If you haven’t explored the Hospital Compare site at, take a moment to select some hospitals (the program allows no more than three at once) to view the data.

Designed for consumers, the site provides information on 26 quality measures, including process of care and outcome measures, for any participating hospital. At the same time that patient satisfaction information was added to the site, so were details on how often Medicare patients were admitted to the hospital for specific conditions and what Medicare paid for services.

You can view the patient satisfaction measures, called “Survey of Patients’ Hospital Experience,” separately. Once you’ve selected two or three hospitals to compare, you’ll see a percentage of patients who were satisfied with each measure.

Finding the most pertinent information available requires a few more clicks. Select a single measure and click on “view graph” or “view table” to see how those hospitals compare with the average for all reporting hospitals in the same state and for all reporting hospitals in the United States. This is the best way to see how a particular hospital compares with others on any given measure.—JJ

What is patient satisfaction? The Hospital Compare site terms this information “Survey of Patients’ Hospital Experiences” and offers a straight percentage of patient satisfaction for 10 areas, including these summary measures:

  • How well nurses and doctors in the hospital communicated with the patient;
  • How responsive hospital staff were to the patient’s needs;
  • How well hospital staff helped the patient manage pain;
  • How well the staff communicated with the patient about medicines; and
  • Whether pertinent information was provided when the patient was discharged.

Additional items address the cleanliness and quietness of the patient’s room, as well as the patient’s overall rating of the hospital and whether the patient would recommend the hospital to others.

About the Survey

The CMS patient satisfaction percentages are compiled from hospital responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

Under CMS’ Reporting Hospital Quality Data Annual Payment Update program, hospitals subject to Inpatient Prospective Payment System (IPPS) payment provisions must collect and submit HCAHPS data to receive their full IPPS annual payment update. Other hospitals can voluntarily participate, but there is no incentive payment.

Hospitals administer the survey to a random sample of their adult Medicare patients (across medical conditions) anywhere from 48 hours to six weeks after discharge. They are allowed to conduct the survey by mail, telephone, mail with telephone follow-up, or active interactive voice recognition, and they either can integrate the HCAHPS questions with their own patient satisfaction survey or use HCAHPS by itself. Hospitals must survey patients throughout each month of the year.

CMS began reporting HCAHPS data in March on responses of patients discharged between October 2006 and June 2007. Results will be published quarterly and will comprise the most recent four quarters of data.

Policy Points

Pa. Offers Version of Hospital Compare

Pennsylvania has its own Hospital Compare-type site that shows how the state’s hospitals stack up against each other. At, the Pennsylvania Health Care Quality Alliance (a consortium of Pennsylvania hospitals, hospital associations, insurers, and the Pennsylvania Medical Society) has posted quality reports that compare performance and outcomes of all 162 primary acute care hospitals in the state. Visitors can find hospitals with the best (and worst) track records for treating heart attacks, heart failure, pneumonia, or preventing certain hospital-acquired infections during a certain year.

SHM-backed Stroke Bill Advances

An SHM-supported bill that would develop statewide systems for stroke care has been passed by the House of Representatives, approved by the Senate Committee on Health, Education, Labor and Pensions, and been submitted for Senate consideration. The “Stroke Treatment and Ongoing Prevention Act of 2007” would authorize a nationwide system dedicated to the prevention, early intervention and treatment of stroke. Under the bill, training and best practice guidelines would be made available for health professionals. The bill would also authorize the Secretary of Health and Human Services, through the Centers for Disease Control and Prevention, to enhance the development and collection of data related to the care of acute stroke patients.

Greater IPPS Payments in ’09?

CMS has released a proposed rule that would boost by 4.1% overall Medicare payments under the inpatient prospective payment system (IPPS) to hospitals in fiscal 2009. Comments on the proposed rule will be accepted through June 13, and CMS will respond to comments on a final rule to be issued on or before Aug. 1. A fact sheet on the rule is available online at media/fact_sheets.asp.—JJ

To the Rescue

Dr. Williams

How will this new aspect of transparency affect hospitalists?

“Hospitals are now going to be publicly exposed, as it were, and there will be increasing pressure on how to optimize these measures,” says Dr. Williams.

For this, they are likely to turn to their hospitalists. “Especially since hospitals spend so much money on supporting their hospital medicine programs, they’re going to want to see some return on that money in the form of improvement in these numbers.”

Although the data were added to Hospital Compare for the education of current and future patients, “I don’t think consumers look at this data at all,” Dr. Williams notes. “However, I think hospitals look at it, and they’ll use it to advertise [when they have impressive ratings on measures]. On these questions, hospitals are going to begin competing with each other.”

Hospitalists should be able to help their hospitals improve on specific ratings, just as they help with current quality and outcome measures.

“A lot of hospital medicine programs have already used patient satisfaction as a metric, with their own surveys,” Dr. Williams points out.

One patient satisfaction measure in particular can be addressed by hospitalists. “For HCAHPS, discharge is the component [with the lowest scores],” says Dr. Williams. “Obviously hospitalists can have a big impact on improving those numbers.”

Your own path to improving patient satisfaction is clear: Start by checking your hospital’s numbers on Hospital Compare—and remember those numbers can change quarterly. Consider how to boost satisfaction rates for some of those measures and get the buy-in you need to make changes that will bring the percentages up and keep them up. TH

Jane Jerrard is a medical writer based in Chicago.

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