New emphasis on patient surveys

At Providence Park Hospital in Novi, the artwork hanging on the walls isn't covered with glass, in an effort to absorb noise.
Tribune News Service
Jan 3, 2013

Special 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 "pain-controlled."

The reason for these changes at Providence Park and similar ones at other hospitals is to ensure high scores on patient satisfaction surveys — the results of which will affect Medicare reimbursement rates, starting this 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.

Amenities 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. But 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 earplugs and relaxation-inducing lavender lotion.

Another survey topic is staff attention.

"Bells 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, chief quality officer for St. John Providence Health System, which includes Providence Park. "We take these things and focus it up from there in addressing the patients' needs."

The Hospital Consumer Assessment of Healthcare Providers and Systems — 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 2012, the start of the 2013 fiscal year.

This month brings five new questions for the survey.

Hospitals are at risk of losing 1 percent of their payouts if they don't do well on the surveys. That will jump to 2 percent by fiscal year 2017.

They 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.

"In 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 patients."

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.

— By Zlati Meyer, Detroit Free Press (MCT)

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