Hospital Readmissions - Top 10 - Washington

ORIGINAL RESEARCH Demographic Factors and Hospital Size Predict Patient Satisfaction Variance—Implications for Hospital Value-Based Purchasing Daniel C. McFarland, DO1*, Katherine A. Ornstein, PhD2, Randall F. Holcombe, MD1 1Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York; 2Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York. BACKGROUND: Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by link- ing payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Health- care Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medi- care & Medicaid Services (CMS) reimbursement. OBJECTIVE: Assess nonrandom variation in patient satisfaction as determined by HCAHPS. DESIGN: Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. SETTING: A total of 3907 HVBP-participating hospitals. PATIENTS: There were 934,800 patient surveys by the most conservative estimate. MEASUREMENTS: A total of 3144 county demographics (US Census) and HCAHPS surveys. RESULTS: Hospital size and primary language (non–English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approxi- mated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteris- tics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. CONCLUSIONS: Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. Journal of Hospital Medicine 2015;10:503–509. VC 2015 Society of Hospital Medicine The Affordable Care Act of 2010 mandates that gov- ernment payments to hospitals and physicians must depend, in part, on metrics that assess the quality and efficiency of healthcare being provided to encourage value-based healthcare.1 Value in healthcare is defined by the delivery of high-quality care at low cost.2,3 To this end, Hospital Value.

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James I. Merlino is a colorectal surgeon and the chief experience officer at the Cleveland Clinic. Ananth Raman is the UPS Foundation Professor of Business Logistics at Harvard Business School. HEALTH CARE'S SERVICE FANATICS How the Cleveland Clinic leaped to the top of patient-satisfaction surveys by James I. Merlino and Ananth Raman THE CLEVELAND CLINIC has long had a reputation for medical excel- lence and for holding dov în costs. But in 2009 Delos "Toby" Cos- grove, the CEO, examined its performance relative to that of other hospitals and admitted to himself that inpatients did not think much of their experience at its flagship medical center or its eight community hospitals—and decided something had to be done. Over the next three years the Clinic transformed itself. Its overall ranking in the Centers for Medicare & Medicaid Services (CMS) sur- vey of patient satisfaction jumped from about average to among the top 8% of the roughly 4,600 hospitals included. Hospital executives from all over the world now flock to Cleveland to study the Clinic's practices and to leam how it changed. The Clinic's journey also holds lessons for organizations outside health care—ones that until now have not had to compete by cre- ating a superior experience for customers. Such enterprises often have workforces that were not hired with customer satisfaction in mind. Can they improve the customer experience without jeopar- dizing their traditional strengths? The Clinic's success suggests that they can. The Cleveland Clinic's transformation involved actions any organization can take. Cosgrove made improving the patient experience a strategic priority, ultimately appointing James Merlino, a prominent colorectal surgeon (and a coauthor of this piece), to io8 Harvard Business Review May 2013 n HEALTH CARE'S SERVICE FANATICS lead the efiFort. By spelling out the problems in a sys- tematic, sustained fashion. Merlino got everyone in the enterprise—including physicians who thought that only medical outcomes mattered—to recognize that patient dissatisfaction was a significant issue and that all employees, even administrators and janitors, were "caregivers" who should play a role in fixing it. By conducting surveys and studies and so- liciting patients' input, the Clinic developed a deep understanding of patients' needs. It gave MerUno a dedicated staff and an ample budget with which to change mind-sets, develop and implement processes, create metrics, aind monitor performance so that the organization could continually improve. And it com- municated intensively with prospective patients to set realistic expectations for what their time in the hospital would be like. These steps were not rocket science, but they changed the organization very quickly. What's more, fears expressed by some physicians that the initia- tive might conflict with efforts to maintain high quality and safety standards and to further reduce costs turned out to be unfounded. Du ...

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Hospital Readmissions - Top 10 - Washington

1. Hospital Readmissions – Top 10 Performing - Washington Hospital Readmissions Reduction Program • In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions. • Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip/knee replacement, and coronary artery bypass graft surgery by the number that would be “expected,” based on an average hospital with similar patients. • A ratio greater than 1.0000 indicates excess readmissions. • Average Readmission Ratio 2013 to 2016 9/24/2018 Jim Basch, MBA, Executive Consultant. Email: jcbasch@yahoo.com Cell: 408.425.4410 Hospital-Top 10 Performing Readmission Ratio CENTRAL WASHINGTON HOSPITAL 0.88 PROVIDENCE SACRED HEART MEDICAL CENTER 0.88 PROVIDENCE ST MARY MEDICAL CENTER 0.88 CONFLUENCE HEALTH- WENATCHEE VALLEY HOSP & CLINICS 0.91 OLYMPIC MEDICAL CENTER 0.91 EVERGREENHEALTH MEDICAL CENTER 0.92 ST FRANCIS COMMUNITY HOSPITAL 0.92 YAKIMA VALLEY MEMORIAL HOSPITAL 0.92 MULTICARE AUBURN MEDICAL CENTER 0.93 ST CLARE HOSPITAL 0.93

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