Patient Satisfaction Scores Lower for Large Urban Hospitals

Hospitals serving large populations of non-native English speakers perform worse on patient satisfaction scores that are tied to reimbursement from the US Centers for Medicare and Medicaid Services (CMS).

With the 2010 implementation of the Affordable Care Act, hospitals have been encouraged to focus more on value-based services as opposed to fee-for-service models. In 2013, CMS’s Hospital-Value-Based Purchasing (HVBP) program began affecting reimbursement for more than 3000 hospitals across the United States, and this program will be fully implemented in 2017.

While CMS uses objective measures of hospital performance to determine reimbursement levels, patient satisfaction scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are also taken into consideration. This subjective measure will count toward 30% of the aggregate score until 2016, when it will decrease to 25% from then on.

To provide insight on how demographic factors and geography can predict hospitals’ patient satisfaction scores, researchers examined 3907 hospitals, 934,800 HCAHPS surveys, and 3144 county demographics and then published their findings in The Journal of Hospital Medicine.

The authors found large, urban hospitals serving more patients whose primary language was not English had lower HCAHPS scores. By comparison, smaller, non-urban hospitals serving more white patients with higher education levels tended to have higher HCAHPS scores.

“…There appears to be a nonrandom pattern of patient satisfaction scores across the country, with less favorable scores clustering in densely populated areas,” the researchers concluded.

To achieve more equity, the investigators developed the Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS), a new formula that “removes excessive influence of the top 4 contributors of patient satisfaction bias that are outside of the control of a hospital,” said senior study author Randall Holcombe, MD, in a press release.

The researchers noted critics of incentive-based programs contend the current reimbursement formulas are unfair to larger hospitals, academic medical centers, safety-net hospitals, and health care facilities in lower-income areas, while physician-based specialty hospitals tend to reap more rewards.

“CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct,” they concluded.