Patient Satisfaction A Law in 2014 - Part I

I'm into my semi-yearly round of medical specialists and tests. At least this year I've agreed to do it since I have taken breaks when I've felt overcooked by the health care community. In no particular order, they include my trusted doctors in rheumatology, gastroenterology, oncology, ophthalmology, and gynecology - my 'ologists.' They and their welcoming staff greet me with hugs and an inquiring: "Where've you been?" They pepper me with dozens of other questions, take blood, give me shots, order tests, and I dutifully try to answer and comply.

I'm a good patient. I bring my updated medications list and medical history along with all the names and telephone numbers of my physicians in both New York and South Carolina. And I have finally found that I am happy with the doctors that work with me. My patient satisfaction level is high.

Why is that so important?

One unsung part of the United States Federal Affordable Care Act enforces patient satisfaction as a factor for physician payments, at least starting with Medicare and Medicaid. It's a "pay for performance" law, according to the Centers for Medicare and Medicaid Services (CMS), a federal governing body established under the The Patient Protection and Affordable Care Act (PPACA). Publicly, we all know it as Obamacare and the patient protection section is to be enforced beginning January 1, 2014.

To summarize: "Quality, pay for performance, and hospital value based purchasing (HVBP) are synonymous terms which are used to indicate that in the future, healthcare hospital reimbursements will be linked to patient outcomes."

Well, whattya know? I have not been a proponent of the ACA, worried that it will turn into a single-payer 'entitlement' system that will benefit the very rich and the very poor rather than the vast middle class. But if what I'm reading in all these documents issued by these highly-acronymed agencies, we patients just might have an impact on the bottom line of healthcare delivery.

That's if we choose to participate because none of my doctors or hospitals except one have ever asked me to fill out a patient satisfaction survey and it was voluntary. The one and only site I can find thus far that the government is using to collect this data about hospital performance and patient satisfaction is RateHospitals.com where patients can "report and rate their hospital experiences." The site says it "is dedicated to improving the quality of healthcare in the United States (and) provides an opportunity for patients to express their opinions regarding their hospital stay."

Furthermore, the site states: "The patient experience is becoming increasingly recognized as a critical component in modern healthcare. The Federal Government has allocated over one billion dollars to reward hospitals across the country which perform well in Patient Satisfaction and Patient Clinical Outcomes."

Reward hospitals with higher reimbursements based on how well they satisfy patients? Really?

My first question is: Who funds and manages this site? I have to do a little journalistic research to find out since it is not a readily-available piece of information; in fact, it is hidden on the actual site. There will be a Part II to this blog entry as I continue to study what I'm reading and make some inquiries.

Today, I sent this email to the only contact information provided on the site:

Hello, I am attempting to learn if your company is under contract by the U.S. government or was developed as a private company to meet some of the demands of the ACA with respect to patient satisfaction. I write a blog about health issues (mostly my own) and would like to understand more how this part of the law works and if your company is the only one providing the government with this information collected from patients or if hospitals and doctors' offices must do so themselves. 
Thank you for your kind consideration. 

In the meantime, I tried the site and this was my experience:

1. To register and sign in, I had to use one of my social media accounts. 
2. I received an email with a temporary password and I changed it.
3. I selected my local hospital and I expected a survey to appear. It did not; just the name and address of the hospital along with a map link. 
4. Along the left side of the page was a list of specialties. I selected a specialty thinking that might bring up the survey. It did not.
5. There was also a list of links to general health care-related articles, none of which would lead me to who was the site administrator or owner.  
6. I refreshed the page and was greeted with nearly a blank screen; just the name and address of the hospital with the map link again and the list on the left. 

The CMS says I should see this:

"RateHospitals.com is a recently developed website which allows patients to rate the experience of their hospital visit. Patients can browse over seven thousand hospitals in the United States, and click on the hospital they visited. After selecting “reviews,” they can then rate their hospital experience according to the following categories: 1) nursing communication, 2) doctor communication, 3) pain management, 4) communication of medications, 5) cleanliness and quietness of the hospital environment, and 6) overall rating of the hospital stay. Patients are also provided the opportunity to add any comments they wish, and share them through email or social media."

We can gossip, too!

"On the hospital page, the visitor can also open up the “gossip” section, and read and post information pertinent to the hospital. Awards and accolades given to the hospital might be seen in this section. The visitor to the site is also provided with demographics about the hospital, as well as a map. Comments and pages on the website can be shared through e mail, or through a variety of social media including Facebook and Twitter, which is supported by this site."

I saw none of this; therefore, I must conclude - at this juncture anyway - the SITE does NOT deliver!

Sound familiar? 

Now, I'm just a frustrated patient who can't provide my input and help change reimbursement rates to hospitals and doctors based on my own patient satisfaction; exactly what the PPACA is saying we must do now by starting to use this particular web site. Since 2010, however, doctors and hospitals were already aware of what was coming down the pike. To explain the almost inexplicable:

"The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey judges performance in the calculation of the value based incentive payment in the Hospital Value-Based Purchasing (HVBP) program, beginning with hospital discharges in October 2012. The HVBP Total Performance Score (TPS) for 2013 has two components: The Clinical Process of Care, which accounts for 70% of the TPS and the Patient Experience of Care, which accounts for 30% of the TPS, and which is based on HCAHPS. The reduction of hospital revenue, based on performance, may be 1.0% in 2013, 1.25% in 2014, 1.5% in 2015, 1.75% in 2016, and 2% for 2017 and subsequent years. For the year 2013, this represent(ed) $1 billion at stake." 

https://data.medicare.gov/Hospital-Compare/Hospital-Value-Based-Purchasing-HVBP-Total-Perform/ypbt-wvdk

I'm not done with this inquiry and I will ask the doctors I am seeing in the next two weeks what they know of the Law and how they are enforcing the mandate that they meet a certain patient satisfaction standard. I will also ask them if they understand that the law, as written, states that their Medicare and Medicaid reimbursement rates will be reduced by from one to two per cent if they do not comply and meet the standards. Sounds like an awfully small figure until you click on some of those links and see how many thousands of hospitals and physicians will be involved.

Diving into the data. Stay tuned...