Medicare ties payments to patient surveys

originally appeared in USA Today from the 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.

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 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.

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. 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.

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, according to 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.

Hospitals 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.

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.

At 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, according to 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.

We don't frankly respond to changes in reimbursement or other national surveys and comparisons, said Beaumont's executive vice president of operations. We've been working for decades to improve patient satisfaction.

He said that less than $3 million is at stake, a tiny portion of the hospital's $2.2 billion operation.

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.

Patient Safety Advocates Band Together

Story first appeared in The Wall Street Journal.

Searching for ways to reduce medical errors and keep patients safe?

Look up.

That’s the idea of some patient-safety experts, who will discuss the formation of an independent patient-safety agency modeled on the National Transportation Safety Board, and other strategies to reduce errors at a summit in Washington.  Baltimore Medical Malpractice Lawyers are following the progress of this new agency.

Many of the safety and error-prevention strategies used in aviation are applicable to health care, such as investigating the root causes of accidents and developing programs to reduce fatalities, experts say. One pilot who will share lessons from aviation’s best practices at the summit: is the retired US Airways pilot who coolly brought down stricken Flight 1549 into the Hudson River with no loss of life.

“Surfing the Healthcare Tsunami,” a new patient-safety documentary looking at solutions such as safety protocols for hospitals, will also premier at the summit. The Discovery Channel will show the film on April 28, with repeats over subsequent weeks.  It will feature a prominent actor and patient-safety advocate, whose 12-day old twins received an overdose of heparin, a blood thinner, in a Los Angeles hospital that put them at serious risk, as the Health Blog discussed in 2008.

The concept of an NTSB for health care first surfaced in a report by the Institute of Medicine and has been taken up by patient-safety advocates led by Dr. Charles Denham. He’s chairman of the Texas Medical Institute of Technology, or TMIT, a nonprofit research group that supports development and dissemination of patient-safety practices.

The idea isn’t to create another layer of health-care bureaucracy, or a new federal agency, but a public/private partnership that could be run at minimal cost to taxpayers — perhaps 10 to 25 cents a year per citizen. Consumers are absolutely shocked that that there is no safety entity for hospitals and health care.


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HOSPITALS TRY TO CUT MEDICARE COSTS AND REPEAT PATIENTS

A combination of giving patients more information about their conditions and better managing their medications can slow the revolving door of Medicare patients in and out of hospitals by about 20%, a study released Monday shows.
Researchers determined that physicians often did not have a complete list of medications that other doctors had prescribed for a patient, so they prescribed drugs that reacted badly with the patient's other medications. Most often, patients did not understand the care they were receiving or needed.
This information can help hospitals better cope with part of the health care law that will force them to repay Medicare for the cost of patients who are readmitted to a hospital within 30 days of their previous stay, researchers said. Previous research showed that one in five Medicare patients returns to the hospital within 30 days of a previous admission.
It costs Medicare $17 billion a year to pay for patients who are readmitted to the hospital within 30 days of their last stay.
The change takes effect in October 2012, and includes re-admissions for heart failure, heart attacks and pneumonia within 30 days of a previous stay. More diseases will be added to the list.
It also turned out to be true that more people were sent home than to long-term care.
The researchers compared 862 patients who entered a rehabilitation center in Boston from June 2009 to May 2010. Patients enter skilled nursing facilities when they are not sick enough for a hospital nor well enough to go home.
Researchers asked patients with congestive heart failure if they would want more surgery that might extend their lives or if they preferred less-invasive treatments. Some chose to manage the symptoms instead of continuing more expensive treatments. Often, patients and physicians had not talked enough for the doctor to realize the patient did not understand his or her medical condition.
Doctors talked to patients who had been admitted more than three times within the previous six months about palliative care, or care that manages symptoms with the understanding that the patient would not recover. They also gave patients copies of all their medications so they could provide that information to future doctors.
The center changed policy so a nurse and pharmacist each checked prescriptions after a doctor saw a patient. They provided details of care so patients could serve as a safety check.