The Affordable Care Act and Patient Satisfaction in Hospitals

The Affordable Care Act of 2010 created a hospital reward system that focuses on quality of care and maintenance of high levels of patient satisfaction. As part of a bigger initiative called the Partnership for Patients, this focus on the quality of care affects how hospitals are paid for Medicare patients. Hospitals are forced to improve their service to patients or risk losing Medicare money.

Since private insurers typically follow Medicare's lead, it's expected they, too, will eventually align reimbursements with patient satisfaction. That means that within a few years, all patients will benefit from this new emphasis on patient satisfaction.

Hospital Follows Standards of Care

Here's how it works: When patients are hospitalized, there are certain tasks that are measured to assess the quality of care provided to them. The majority of the tasks relate directly to standards of care. For example, a patient who arrives at the hospital in the midst of a heart attack must receive "fibrinolytic medication" (medication which dissolves blood clots) within 30 minutes, or an antibiotic must be provided to a patient within an hour of a surgical incision to reduce the risk of that patient acquiring a surgery-triggered infection.

Here is an example of what the survey might look like and the questions that are asked.

Standards of care also called best clinical practices, are one very important aspect of quality. However, hospital patients are usually unaware of whether those are being followed and rarely even know whether to ask about them. Therefore, patient satisfaction usually isn't dependent on them, and unless the patient or the family discovers later that a standard wasn't followed and the patient's recovery is diminished or the patient dies, as a result, patients may never know whether those standards were followed. The total responsibility for measuring whether those standards are being followed will fall to the hospital.

Patient Satisfaction Surveys

What patients are aware of, are the measurable aspects that we experience. Communication with hospital personnel, attention to pain levels, explanations about medications, discharge instructions. These are all aspects of hospital care that patients experience—or don't experience—that we can quantify ourselves.

To measure how satisfied we patients are with how we experienced our care, patients are surveyed randomly. The survey questions ask patients how satisfied they are with some or all of the following aspects of their care:

• How well nurses communicated with patients
• How well doctors communicated with patients
• How responsive hospital staff were to patients’ needs
• How well caregivers (referring to hospital personnel) managed patients’ pain
• How well caregivers (referring to hospital personnel) explained patients’ medications to them
• How clean and quiet the hospital was
• How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions)

If you are hospitalized, you may receive one of these surveys. Here is some advice on how to fill out one of the patient experience surveys.

In October 2012, Medicare began rewarding the best performing hospitals with bonuses—money that was saved by not reimbursing doctors and hospitals for mistakes they made or was saved through other reductions in reimbursements.

How Does This Initiative Improve Patients' Satisfaction?

Beyond the obvious and assumed improved patient experience in hospitals, and the new focus on communications, we patients will also begin to see some renewed respect from hospital personnel.

What we patients can't influence are the clinical practices required by this new payment approach because we mostly don't understand the medicine behind them. Whether or not they are performed appropriately, and whether or not they are recorded appropriately, is left entirely up to hospital personnel. If a hospital wants to game the system, it will, and there is very little we patients can do to fight that. Billing, coding, recording, and medical mistakes take place every day in hospitals. This initiative will not make them any more accurate or honest than they are today and may entice some to be less than honest.

Any coding and recording mistakes will affect our records, so to the extent you, the patient, can get a hold of your medical records and correct them if need be, that will be helpful should you need treatment later.

The one aspect of this initiative hospitals will not be able to game will be the answers patients give to their survey questions about their experiences (as listed above). Most of these surveys will be a certain type called an HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems—pronounced "H-caps").

The first HCAHPS surveys were administered beginning in 2006. The first hospital scores were reported at the Department of Health and Human Service's Hospital Compare website in 2008. In fact, the Medicare Find a Hospital website, including the scores hospitals have received based on those surveys, is one tool for choosing the best hospital for you.