Every person working in or adjacent to the healthcare industry knows there is a shortage of care providers. Though this staffing shortage primarily impacts rural patients and high-burnout specialties—such as neurology, internal medicine, and emergency medicine—it has consequences for patients and facilities across the country. One method recruiters and healthcare staffing agencies use to determine the need for locum tenens or full-time providers is analyzing quality performance.
At Definitive Healthcare, we help our clients develop a strategy to identify facilities in need of additional staffing using several key hospital performance metrics. One way we do this is through analyzing clinical metrics from Medicare and all-payer claims. For example, if a hospital has high mortality rates for stroke patients, that indicates a need for clinicians who have more experience treating strokes as well as common comorbidities such as hypertension, hyperlipidemia, and history of nicotine dependence.
Fig 1 Image is a screenshot of the DHC Visuals product within the Definitive Healthcare platform and is a display of the top 10 most common comorbidities for patients who have had a stroke. Information is from calendar year 2017, the most recent available.
However, even if a hospital’s clinical and quality performance is strong, patient experience is a vital component of quality scoring. Hospitals participating in the value-based care (VBC) program are scored based on four categories: patient experience, clinical care, efficiency and cost reduction, and patient safety. A hospital could be in the top percentile for 30-day readmissions and serious complications, but its scores could drop if too many patients report having a negative experience.
HCAHPS patient satisfaction scores are the most obvious indicator of staffing need. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient satisfaction survey that allows patients to rate aspects of their hospital stay through a set of value statements, from a scale of “strongly disagree” to “strongly agree.”
The scores from each question are aggregated and averaged into an overall star rating, with one being the worst and five being the best. According to Definitive Healthcare data, the average score for all reporting hospitals in 3.25 stars.
One of the most telling HCAHPS measures is “Patients who reported that they "Always" received help after using the call button as soon as they wanted.” If this score is lower than the national average, there are likely too few clinicians to properly address the volume of patients in a timely manner.
The other most indicative HCAHPS measure is “Patients who "Strongly Agree" they understood their care when they left the hospital.” Discharge information is vital for ensuring positive patient outcomes, which reduces readmissions and lowers total healthcare costs.
If the score for this measure is lower than average, the issue is usually either 1) a hospital is understaffed and does not have enough clinicians available to comprehensively explain post-acute care, or 2) there are communication barriers that prevent clinicians from explaining discharge information to patients in a way they understand.
Barriers to Physician-Patient Communication
There are three primary barriers in physician-patient communication: language used, patient education level, and patient economic status. Of course, these are not the only obstacles clinicians and patients face in understanding medical needs—but they are some of the most common and relevant for staffing and recruiting purposes.
If a patient is a non-native English speaker, or does not speak English at all, it can be difficult to ensure the patient and their caretakers understand post-discharge care. Though most hospitals have access to translators and multilingual clinicians, there are instances in which the patient’s preferred language is uncommon or there is not a translator immediately available. Additionally, some smaller or rural hospitals may have difficulty offering the appropriate translation services due to logistics like location and cost.
Patient demographic information can be gleaned from a variety of sources. To understand the languages a clinician is likely to encounter at a facility, CBSA is a good place to start. CBSA, or core based statistical area, is a metropolitan or micropolitan region—essentially, a city and its surrounding suburbs.
If a hospital is in Houston, Texas or the surrounding area, there will likely be a high volume of patients speaking Spanish. Similarly, if a hospital is located in the Minot, North Dakota CBSA (CBSA code 33500), it could encounter patients from the Fort Berthold Reservation who speak native languages like Arikara.
Often language is tied to race and culture, which could serve as another barrier to communication. CBSA information is taken from the U.S. Census Bureau, and includes insights on race, gender, age and other demographics. Patients, particularly older males, may appear to be stoic and unphased by a severe or chronic diagnosis. This is especially true if the patient is surrounded by family and clinicians.
In this case, it is important for an individual clinician to establish rapport and check in with the patient to ensure they understand the full scope of their diagnosis rather than make any assumptions.
Fig 2 Image is a screenshot of the profile for the Minot, ND CBSA profile (CBSA code 33500), including financial and clinical information.
Education and language are closely intertwined when discussing clinician and patient communication. A hospital serving primarily upper-class patients with advanced degrees will likely have fewer issues explaining medical complexities in a way the patient and their caretakers understand.
Alternatively, in areas where patients have primarily achieved a high school degree or lower, there could be greater difficulties in explaining conditions in layman’s terms. This is a generalization, as formal education doesn’t dictate knowledge, but it is a contributing factor.
In addition to race and gender, CBSA information can be used to analyze the average education level of people living in a metropolitan or micropolitan area. In the Minot, North Dakota CBSA, 30 percent of the population reported “some college or associate’s degree.” This is followed by 23 percent of the population reporting “high school or GED.” Only 4 percent reported earning an advanced degree.
In contrast, nearly 13 percent of the population in the Boston-Cambridge-Newton, Massachusetts CBSA (CBSA code 14460) reported earning an advanced degree. These patients may have an easier time understanding medical terminology and have the resources to seek higher quality care post-discharge.
3. Economic status
Though economic status may not impact the likelihood of a patient understanding discharge information, it would influence where—or even whether—a patient seeks post-discharge care. If a patient qualifies for Medicare or state insurance, clinicians should ensure there is a pharmacy nearby that the patient can access.
Similarly, if a patient needs to see a specialist or attend physical therapy, clinicians should be referring the patient to a provider that accepts their insurance. Often medical care is financially prohibitive, and if a patient cannot access post-acute care then there is a much higher likelihood of negative care outcomes like readmission and mortality.
Patient economic status can be found or inferred form multiple sources. Once again, CBSA is a useful resource for general information. Often patient economic status is related to educational achievement, but this is not always accurate. Patient characteristics are included in CBSA profiles like the one above, including Medicaid eligibility and the number of Medicare beneficiaries in one region.
Both of these can be used as surrogates for income information. In the Minot, ND CBSA, nearly 15 percent of the population is eligible for Medicaid—meaning that over 11,000 people meet the income criteria for membership. However, only 1,503 people are reported to actually be enrolled in Medicaid in that CBSA.
Hospital payer mix is another way to analyze patient populations on a more granular level. According to Definitive Healthcare data, Assumption Community Hospital in Louisiana has a payer mix that is 58 percent private payers, 25 percent Medicare, and 17 percent Medicaid.
Nearly half of the hospital’s patient population is utilizing government insurance programs, which means clinicians have to be especially attentive to offering recommendations for post-discharge care that they can both understand and access.
Fig 3 Image is a screenshot of the profile for Assumption Community Hospital in Napoleonville, LA. The image features payer mix and payer information.
Filling in the Physician Gaps
HCAHPS measures like those listed above are indicators that a hospital is understaffed. When recruiting and training new clinicians, it is important that the new staff can effectively connect with the patient population treated by their new facility. This means that hospital staff should, in many ways, reflect the identities of the patients they serve.
Sharing identity helps physicians empathize with patients and facilitates clear communication, making it easier to meet patients where they are. When clinicians understand patient backgrounds, they are also better able to address social determinants of health, which strongly influence overall wellness and care outcomes.
Interested in using clinical and quality metrics to identify your ideal prospects? Definitive Healthcare tracks performance measures from more than 8,800 hospitals and IDNs across the U.S., as well as hundreds of thousands of physician groups and outpatient surgery centers.
See how providers are leveraging value-based care performance in our Webinar: Measuring Success in Value-Based Care - Strategic Perspectives Across Healthcare.
This panel will cover:
Tangible impacts of value-based care in both the provider and payer perspectives
Defining success with value-based care transition
Specific metrics when it comes to measuring value-based care performance
Actionable steps in implementing value-based care focused changes