Healthcare reform: quality, not quantity

Are El Camino Hospital’s patients happy with their care? In anticipation of the unrolling of the Obama Administration’s healthcare reform package, El Camino will begin contracting next month with Quality Data Management to conduct patient satisfaction surveys.

According to Dr. Eric Pifer, El Camino’s chief medical officer, the surveys will help the hospital identify areas where improvement is needed. The ultimate aim is to boost the organization’s score on the federally administered survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS.

Beginning in 2013, Medicare — the government-sponsored insurance program for seniors — will begin holding back a percentage of total reimbursements to hospitals that do not achieve an adequate survey score, Pifer said.

During the first year of implementation, Medicare will withhold 1 percent of payments to low-scoring hospitals, Pifer said, and the penalty will eventually creep up to 2 percent by 2017.

With Medicare payments accounting for around 40 percent of El Camino’s total revenues, it is not an insignificant penalty. Pifer estimated that losing out on 2 percent of Medicare payments could cost the hospital about $4 million.

“It’s certainly not nothing and it would behoove us to focus on it,” Pifer said.

Rewarding hospitals for producing high survey scores is intended to refocus the health care industry, Pifer said. Currently, doctors and medical providers in America have plenty of monetary incentive to see as many patients as possible and administer as many procedures as they can reasonably justify. The more patients in the door and the more tests ordered, the more they can bill insurers.

Healthcare reform aims to change that by rewarding physicians and hospitals for quality, not quantity.

“It’s about how well you deliver care instead of how much care you deliver,” Pifer said.

Quality Data Management will survey patients in much greater detail than the HCAHPS survey does, Pifer said. The survey will question patients on a wide range of topics, including quality of care, nurse response time, cafeteria food and parking. The aim is to drill down and discover what is at the root of every patient experience.

What defines a good patient experience will differ with every individual and depend on the nature of the hospital visit, Pifer said. That’s why it is important to go beyond the 27 questions on the HCAHPS survey, he said.

“These surveys give us a clear picture of what we need to do to make patients happy,” Pifer said. “If you don’t do something like this, you really won’t be able to direct your efforts in a way that (is) cost effective and appropriate.”

Pifer said that the healthcare reform bill is on the right track — especially in establishing incentives for hospitals to make their patients happy rather than simply prescribe more drugs and tests.

The system is broken, he said, and costs can stand to be greatly reduced before the quality of care is impacted. However, getting there will be difficult, as the system was built piecemeal over time and has many “features that create perverse incentives.”

“The direction is good,” Pifer said. “But I think the implementation is going to be rocky. We’re going to go through a shaking-out period over the next decade or so, after which we will have a more rational system.”