Cooperating for better care.


Tag Archives

Patient complaints: Geisinger lets it hang out


Putting it in the complaint box.

CMS star ratings  for hospitals are related to patient satisfaction with care experiences based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures. The survey covers such things as   how well nurses and physicians communicated with patients, responsiveness of hospital staff to patient needs,  the cleanliness and noise level of hospital environments  and how well patients were prepared for life after they left  the hospital.

Opponents of  CMS star ratings  complain that they oversimplify complex data, conveying  misleading information that can hurt reputations and reflect unfairly on certain hospitals.

However, Healthcare Dive reports that the move toward value-based care and transparency has led some healthcare organizations – such as Intermountain Healthcare and Geisinger Health System – to publish what patients think of them, for better or worse.

“Patient stories have a greater impact on clinicians more than metrics like HCAHPS,” Dr. Greg Burke, chief patient experience officer at Geisinger, told the publication  after a  recent panel discussion.

Geisinger has gotten a lot of publicity because of its unorthodox implementation of its “ProvenExperience money-back guarantee.”   Dr. Burke said that Geisinger posts on its Web site about 97-98 percent of the comments it receives from patients on the system’s clinicians.

He explains why and how the system does this. Please hit this link to read the full article.


The bottom line of reducing clinical variation


Donna Hopkins, R.N., vice president for  the healthcare-consulting firm Novia Strategies, led a Becker’s Hospital Review seminar on reducing clinical variation to improve hospitals’ bottom line. As Becker’s noted: “Clinical variation involves the overuse, underuse, different use and waste of healthcare practices and services with varying outcomes.”

“Reducing clinical variations means creating uniform clinical guidelines and order sets, reducing tests and procedures, eliminating care gaps and delivering true interdisciplinary care,” said Ms. Hopkins.

The panel’s participants discussed successes in clinical variation.

Here are  some highlights:

Steven Goldstein, CEO of Strong Memorial Hospital, in Rochester, N.Y., said reducing clinical variation within clinical redesign efforts is, in Becker’s paraphrase, “imperative for staying viable under risk-based payment models, and CMS’S goal to link 50 percent of Medicare payments to value-based reimbursement models by 2018 has fueled the sense of urgency around such efforts.”

Patrice M. Weiss, M.D., CMO, of Roanoke, Va.-based Carilion Clinic,  said that after the American College of Obstetricians and Gynecologists recommended in 2013  refraining from inducing elective deliveries before 39 weeks of gestation, Dr. Weiss pushed to eliminate them at Carilion altogether.

“We quickly became one of the lowest early induction rate hospitals,” she said, noting that her hospital’s rate was less than 1 percent. “Then we received a letter from the state of Virginia that said a different Carilion hospital had a 17 percent early induction rate.”

Becker’s reported: “Dr. Weiss said she realized then that reducing clinical variation means hospital executives must know the differences in practices between hospitals, even within one system.”

Shelly Hunter, CFO of Mercy Hospital Joplin (Mo.),  noted:

“If you have wide variation, you have less predictability in your finances, which leads to lower operating performance.”

She  continued, in Becker’s paraphrase: “With standardized care, there are better outcomes for patients, fewer complications, lower rates of readmission and higher performance on other quality-based metrics that are tied to reimbursement. Importantly, as hospitals zero in on eliminating waste and duplicative services, standardized clinical pathways help reduce over-utilization of tests and labs. On the other hand, with high clinical variation and erratic utilization, it’s much more difficult to accurately predict costs.”

“In addition to quality-based metrics, patient satisfaction scores measured by HCAHPS affect federal reimbursement to hospitals. Clinical variation has the potential to derail patient satisfaction because lack of standardized care can lead to medical errors, complications, increased length of stay and readmissions, among other issues.”

“It is absolutely key that physicians are on board and engaged” with clinical variation reduction efforts, said Dr. Weiss.  She added (Becker’s paraphrase): “Achieving systemwide physician engagement requires identifying and naming physician champions to serve as leaders. A strong physician champion is clinically active, highly respected by their peers, enthusiastic about effecting positive change and a strong communicator. While hospital administrators might be inclined to turn to department chairs or the most productive physicians to serve as physician champions, these factors alone don’t mean a provider will be a successful leader.”


Nancy Lakier, R.N., CEO of Novia, said that physicians are, in varying degrees, scientists. and so will want to see data before they change.  “When physicians look at solid risk-adjusted data, and they don’t feel that they are being told what to do but rather being supported with data, we find they very quickly use this information to improve the care they provide for their patients,” she said.

To read the whole story on the Webinar, please hit this link.


How to close hospitalist-patient communications gap


FierceHealthcare and the New England Journal of Medicine’s Catalyst report on how Rush University Medical Center improved  what had been relatively bad hospitalist-patient communication in its patient-centered initiative.

A NEJM Catalyst blog post  explains how the medical center has now achieved a domain score for physician communication above the 50th national percentile; the improvement rate for Rush hospitalists has improved faster than for its non-hospitalists’.

The post offers the following suggestions, as summarized by Fierce, for hospitals that “want to open channels of communication between hospitalists and patients–efforts that may lead to higher patient satisfaction scores, reduced readmissions and greater compliance with after-care instructions:”

  • “Provide hospitalists with your current patient survey results. Make sure the reports are timely and transparent.
  • “Make communication a priority and include it as a group performance measure. Provide hospitalists with ongoing education and feedback.
  • “Encourage hospitalists to use facecards, whiteboards and rounding protocols to enhance communication.
  • “Use the HCAHPS database to create a more vigorous measurement tool for hospitalist programs.
  • “Use Lean strategies to identify drivers for variations in scores over time.”

Yelp given high marks in plumbing patient experience


A study in Health Affairs found that Yelp reviews went deeper into the patient experience than the HCAHPS survey. That’s in part because  in-hospital patients and patients’ family members posted reviews.  Reviews included  comfort, billing issues and hospital costs. Only discharged patients are queried in the HCAHPS survey.

Don’t depend on financial carrots in healthcare


Thomas Dahlborg, writing in Hospital Impact, warns about what he sees as the problems in depending on financial incentives in healthcare.

…{A}s we continue to move from productivity-based reimbursement to quality-based reimbursement via the Accountable Care Organization and other payment reform models, a large caution sign is illuminated before me.

“And of course this led me to the Harvard Business Review and “Why Incentive Plans Cannot Work”.

“Rewards do not create a lasting commitment. They merely, and temporarily, change what we do.

“People are likely to become less interested in their work, requiring extrinsic incentives before expending effort.”

“In addition, it’s very important to me as a patient, as a family member of patients and as a healthcare leader to know that those who are caring for those I love are doing so because they truly care–and not because they are being financially incentivized to do so. ”

“Yes, perhaps the financial incentives will change behavior (temporarily), and perhaps it will even have an impact on HCAHPS and other satisfaction and experience scores. But even if those scores were not affected only temporarily, do you really want a healthcare system to be driven by financial rewards rather than an enduring commitment to quality and safety by people who truly care?”



Financial incentives may temporarily change outcomes, but they do not change hearts.

  • Let’s not edge the humanity out of healthcare via over reliance on financial drivers of change.
  • Let’s focus on changing adaptively rather than with a quick financially based technical fix.
  • Let’s focus on bringing humanity back into healthcare once again.
  • Let’s eliminate existing barriers to true caring.


How to get high patient-satisfaction scores


Hanan Aboumatar, M.D., an assistant professor of medicine at Johns Hopkins  and member of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, says there are various ways for a hospital to get high scores in the Consumer Assessment of Healthcare Providers and Systems  (HCAHPS).

She notes that such simple practices as proactive rounds by nurses and hospital leaders can have major positive effects on their patient-satisfaction scores.

She told Becker’s Hospital Review that most hospitals have prioritized patient experience  have taken different routes to get there, to varied results.

“People used different strategies,” she says. “There was no formula [and] some did better than others.”

However, the survey did find some things in common.

Becker’s reports that “One of the most-reported strategies from respondents involved their organization’s culture. A majority — 77 percent — of hospitals reported that a commitment to patients and their families is integrated into their culture, and they attributed their high patient safety scores in part to this mindset.”

“‘The organizations [that] are high-performing were ones [that] did not think of the patient experience as an add-on,”’ Dr. Aboumatar  told Becker’s “‘They thought of it as much more integral to the type of mission that they have. [It’s] what they’re all about.”‘

The importance of staff engagement  in improving patient experience also stood out to Dr. Aboumatar from the survey.

“The survey responses showed 83 percent of surveyed hospitals had proactive nurse rounds in place, and 62 percent reported that leaders from all levels of the organization also rounded on patients,” Becker’s reported.

“Some respondents indicated that leaders blocked out time in their calendars to round on patients and staff, asking patients how their stay is and asking staff what, if anything, they need to help them do their job to the best of their ability, according to Dr. Aboumatar.”


The most popular hospitals


A HCAHPS survey shows the 45 hospitals in which at least 92 percent of patients said they would recommend the hospital. Interestingly, many are surgical hospitals.


The national average rate of hospital recommendation is 71 percent, according to Hospital Compare.


Contact Info

(617) 230-4965

Wellesley, Mass