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LI hospitals can ill-afford low patient satisfaction scores

(L-R) Patti Conners visits her mother, Mildred McMahon,

(L-R) Patti Conners visits her mother, Mildred McMahon, of Port Jefferson, at Mather Hospital in Port Jefferson. (Jan. 30, 2013) Credit: Newsday / John Paraskevas

Long Island hospitals score among the lowest nationally in how satisfied patients are with their experience, a situation that could now cost them big money.

As of Oct. 1, the federal Centers for Medicare & Medicaid Services (CMS), as part of the Affordable Care Act, began tying reimbursements to hospitals in part to how well they score on a 10-question survey that rates how satisfied patients were with their hospital stay.

Many hospitals here rank average or better in quality of medical care. But how Long Islanders answer questions about whether nurses and doctors communicated well with them, whether their pain was controlled or whether their room was clean and quiet will spell millions of dollars for local hospitals.

"We need those Medicare dollars," said Dennis Connors, chief excellence officer for the North Shore-Long Island Jewish Health System. About $7 million in reimbursements are at stake for North Shore-LIJ.

While many Long Island hospitals rank average or better in the quality of medical care delivered, they fall below the national average in all 10 questions that rate patient satisfaction in CMS data released in January. CMS requires regular updates on an array of medical outcomes as well as on patients' hospital experience from most U.S. hospitals.

Compared with other states and the District of Columbia, New York State scored second from the bottom in six questions, third from the bottom in two questions, fourth from the bottom on one and came in dead last on another.

And many Long Island hospitals often score below the New York average: Eighteen of 23 Island hospitals ranked below the national average on how patients rate the hospital overall; nine of those also scored below the state average. Thirteen were below the state and national average in how well doctors communicated with patients. Twelve hospitals were below the state and national average in whether patients received help quickly from staff, in how quiet their rooms were at night, and in how patients rated rooms' cleanliness.

Island hospitals are taking different approaches to try to boost their scores. Each day, employees at John T. Mather Memorial Hospital in Port Jefferson gather to hear inspirational readings on how to be more committed to their patients and fellow workers.

At Brookhaven Memorial Hospital Medical Center in East Patchogue, every patient admitted gets a visit -- and cellphone number -- from a member of management.

Winthrop-University Hospital in Mineola has had carts oiled so they don't squeak and keep patients awake.

Experts can't entirely explain why local hospital satisfaction scores are so low, given that the measures of actual care are on par, for the most part, with other hospitals nationally.

Kevin Dahill, chief executive of the Nassau-Suffolk Hospital Council, said the scores differ "probably for a variety of very obvious and not-so-obvious reasons," including noisy, cramped, aging facilities and a "disproportionately large elderly population."


'No different than U.S. rate'

Among nine CMS "quality of care" measures released in December that look at a range of complications, Long Island hospitals score "no different than the U.S. rate" in fatal complications after surgery, lung collapse and postoperative wound reopening.

Local hospitals either do better than average or average on death rates for heart attacks, heart failure and pneumonia compared with the national rate.

But LI hospitals don't do well overall in CMS' measures of hospital-acquired conditions. Thirteen of 23 hospitals show higher than national rates of severe pressure sores. Ten show higher than average rates of falls and traumas, and 11 show higher than average rates of vascular catheter-associated infections.

Dahill said "no one answer" could explain why that number of LI hospitals don't do well in certain areas. "We are talking about very small statistical differences in rates of occurrence," he said. "Just one very complicated case can change the overall statistical picture for a facility."


No money for low scores

The Affordable Care Act forces hospitals to raise their scores on clinical and patient satisfaction measures -- or lose money. Withholding 1 percent of Medicare reimbursements, CMS will reward hospitals that get high scores with a portion of that 1 percent. Those with low scores won't get any.

For fiscal year 2013, 70 percent of that 1 percent is based on certain clinical measures. The other 30 percent will be based on patient satisfaction.

"There are going to be winners and losers," Connors said.

What worries local hospital executives is that, while they are scrambling to raise their scores, so are others around the country.

"You must continually improve because the nation is continually improving," said Monica Santoro, vice president and chief quality officer at Winthrop. She said the hospital could gain or lose about $1 million in reimbursements.

Over time, different quality measures will be added and account for different percentages of the reimbursement pie. But patient satisfaction scores will remain at 30 percent. "That means it's really important," Santoro said. "They see the value of a patient-centered approach."

Hospital executives are at a loss to explain why Long Islanders appear so unhappy with their hospital experience. Many conjecture that they are sophisticated, have high expectations and aren't used to lavishing praise.

Not incidentally, Long Island has the highest malpractice insurance rates in New York; people who are dissatisfied tend to sue more.

Other executives also point to the diversity of the patients.

"You have a complicated and diverse patient population that is polyglot . . . with a multiple array of social and clinical challenges," said Arthur Gianelli, chief executive of Nassau University Medical Center.

Gianelli said NUMC's status as a safety net hospital is no excuse for not improving patient satisfaction.

NUMC scored below the state and national average in all 10 measures and had the lowest scores among the Island's hospitals in eight of 10 measures.

Dr. Joel Yohai, executive vice president for medical affairs and chief medical officer at Catholic Health Services, praised the patient-centered culture at CHS' St. Francis Hospital in Flower Hill. St. Francis scored the highest of Long Island's hospitals in six of 10 questions and above the national and state average in another three. But he also pointed out that St. Francis specializes in heart care and deals with fewer emergencies, compared with Good Samaritan Hospital Medical Center in West Islip, also part of CHS, which ranked lower on many questions.

"Not to take away from St. Francis, but Good Sam sees about 100,000 a year in the emergency department," he said.

Some point to the fact many Island hospitals are older with less than hotel-like accommodations. Others question whether that affects satisfaction levels.

"There are hospitals with state-of-the-art this and that that still have horrible outcomes, and there are dilapidated hospitals that probably have duct tape in the ORs but are higher performing," said April Fairey, a consultant for Mather from Baptist Health Care based in Pensacola, Fla..


'Much more than being nice'

Dr. John D'Angelo, who was chairman of the emergency department at Glen Cove Hospital from 2005 until he was promoted in September, said he had expected to see an improvement in the department's patient satisfaction scores when the hospital revamped its emergency department in 2003. But the scores didn't budge. It was only when in 2006, they began to reduce the wait time from 90 minutes to 20 minutes that scores began to rise, said D'Angelo, now senior vice president of the North Shore-LIJ Health System's emergency medicine clinical service line. In the latest CMS data, Glen Cove ranked above national and state averages in four measures and above the state average in another five.

"It had nothing to do with bricks and mortar," he said. Instead, he said, it had to do with streamlining admissions.

"Patient satisfaction is much more than being nice," he said. But having a staff that is "nice" is part of it, Fairey said. said. When she began working with Mather four years ago, she said, she had a hard time getting staff to make eye contact.

"It was very basic stuff," she said. "You make eye contact at 10 feet and speak to the person at 5 feet. They were really opposed to it at first."

That has changed. Now, staff do appear to regularly make eye contact with each other and strangers alike. And the scores have risen. Mather recently scored above the national and state average in seven of 10 questions and above the state average in the other three.

Patients seem to notice the difference when hospitals try to focus more on humanizing what can be a painful, scary and lonely time.

Dennis Calbi, 70, of Carle Place, battling renal cell cancer, said his relatives wanted him to go to a hospital in the city. But he said he liked the care he was getting at Winthrop. "From the guy who sweeps the floor to the surgeon, they are all very caring," he said.