Good Medicine is Good Business

Latest Pulse Report underscores link between quality patient care and profitability

Amid continuing uncertainty and concern surrounding healthcare reform, potential cuts to federal funding and the search for sustainable reimbursement methodologies, Press Ganey’s 2011 Pulse Report uncovered a little good news … providing quality patient care increases profitability.

Released at the end of 2011, the broad-based perspective of key trends across the healthcare continuum found hospitals, medical groups and home health agencies are all focusing on ways to improve clinical quality scores in advance of public data reporting requirements and pay-for-performance reimbursement plans. For those who have been successful in delivering coordinated, cost-effective, quality care, a healthier bottom line appears to be one outcome, along with improved physician and employee engagement and higher patient satisfaction ratings.

Deirdre Mylod, PhD, vice president of Improvement Services for Press Ganey, said the trend information is derived from the company’s vast benchmarking databases combined with public data on hospital profitability and federal survey information from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to provide a picture of healthcare delivery in the United States.

Mylod said Press Ganey, a performance improvement company that works with more than 10,000 healthcare organizations worldwide, has the largest private-sector database on patient approval ratings. In this country, she noted, “More than 50 percent of hospitals work with us on patient satisfaction.” The company, she continued, is third largest when it comes to data on core measures on the clinical side.

Analyzing these data sources, the 2011 Pulse Report found the top 25 percent of U.S. hospitals with the highest scores on the HCAHPS question concerning performance were, on average, the most profitable and had the highest clinical scores, which suggests an interrelated link between patient experience, clinical outcomes and profitability.

That link between performance and profitability is anticipated to only grow stronger in the current reimbursement environment. In fact, Mylod pointed out, hospitals are on the cusp of Value-based Purchasing (VBP). Beginning with fiscal year 2013, which starts October 2012, CMS will withhold a portion of the baseline MS-DRG payments across all patients. However, hospitals have the opportunity to recoup all or part of that sum by hitting benchmarks on quality measures and patient satisfaction.

Mylod likened it to a parent withholding allowance but allowing a child to actively earn it back. Each performance measure is scored both on achievement and improvement. The higher of those two numbers is used to calculate a VBP score, which ultimately determines how much of the withheld payment will ultimately be returned to the hospital. The first year, 1 percent of payments will be withheld, but Mylod said that amount will ultimately scale up to 2 percent.

Between pay-for-performance, population health reimbursements and transparency measures making quality data more accessible to consumers, Mylod said it is critical for providers in all care settings to focus on quality and satisfaction. Happily, over the past five years, there is evidence that increased attention to these matters is resulting in positive outcomes.

Data shows satisfaction has steadily risen in the inpatient setting … with the caveat that approval rates dip each year in the late winter/early spring before continuing an upward trajectory. One theory for the annual seasonal drop is higher occupancy during those months, which can lead to higher staffing ratios and overloaded caregivers.

The overall numbers, however, show steady improvement. In January 2007, approximately 64 percent of hospitalized patients gave “top box” marks (a score of 9 or 10 on a scale of 0-10) to the facility. By October 2011, that highest level of satisfaction had risen to greater than 68 percent.

Similarly, satisfaction rates are strong for medical practice specialties and home care providers. Overall satisfaction among the top 25 practice specialties topped 90 percent with oncologists leading the way at 93.8 percent, followed closely by cardiologists at 92.9 percent. Nurses garner the highest approval ratings in the home care sector with more than 93 percent of patients expressing satisfaction with their nurse. While “dealing with the home care office” comes in at the lowest approval rating, overall satisfaction with this sector still tops 87 percent.

“The continued upward trend is very, very good news for the public,” said Mylod. Hospitals and other care settings, she continued, are listening to patients and making changes. “They are enhancing the quality of care being provided so American consumers are getting greater value for the care they are increasingly paying for.”

Mylod said that looking across five years of Pulse Reports provides insight into the trends driving data. Of particular interest to her has been the approach to improving quality and satisfaction. Healthcare organizations are moving away from working in silos to address issues.

“The interaction among quality professionals in the hospital is much greater today than five years ago,” she said. “For example, a service excellence committee might not have been a multidisciplinary team back then.” Today, however, such committees tend to recognize the interdependent nature of most issues.

For example, the fault for long wait times for emergency care rarely is confined to the Emergency Department. Often those providers are waiting for on-call specialists, open operating rooms or available inpatient beds. In turn, an open bed might be waiting on custodial staff to turn a room or for a discharge professional to signify space is available for occupancy. “Again,” stressed Mylod, “it’s the idea of breaking down silos.”

Another shift in approach is the manner in which patient satisfaction and quality is addressed. Historically, she noted, training or consultative activities were more about general education on the importance of patient satisfaction and safety. That method, she said, missed the target. Clinicians and other staff were already committed to patient-centered care. The disconnect came from not consistently applying best practices.

“It goes far beyond helping people understand the importance of patient satisfaction and is much more about identifying the specific processes or behaviors that are not optimal and then fixing those,” she said of today’s quality environment.

Despite the generally encouraging news … and vast amounts of money poured into the healthcare system … the Pulse Report points out that not every healthcare facility has made the necessary gains in quality. Using information from the Commonwealth Fund Commission’s 2011 national quality scorecard, only about half of the 22 indicators used to assess quality showed improvement. However, that same scorecard found quality and the delivery of evidence-based care does substantially improve when effective programs requiring data reporting are implemented.

Across all care settings, how providers respond to a patient’s complaints and concerns, emotional needs and desire to be included in treatment decisions are other areas in need of improvement. “To what extent is that whole person being addressed?” Mylod questioned. “When care breaks down, organizations need a service recovery process. You need good communication flow in both directions.”

Mylod pointed out that American culture has changed over time to a point where information is expected … and often demanded … by patients, and she noted this is an area where providers have the biggest opportunity to make gains in satisfaction rates. “We need better communication with patients and better engagement so we’re bringing them into the fold and making them part of the care team,” she said.

Ultimately, the hope is that the 2011 Pulse Report serves a similar role in providing information and then encouraging engagement to find solutions to issues requiring attention. “I love data,” Mylod laughed, “but what gets us excited is the improvement component.”

While there is clearly room for improvement across the continuum of care, Mylod said overall the 2011 Pulse Report is encouraging. “The healthcare industry is under a lot of pressure – financial … structural. In the midst of all of this, it’s evidence of a lot of great work being done.”