The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measure provides an important patient perspective on hospital performance—one which affects Medicare reimbursements.
This patient satisfaction survey is a publicly reported, qualitative evaluation of hospital care and conduct administered year-round to a random sample of patients up to six weeks after hospital discharge.
Patients rate their hospital stay based on a number of different quality measures, and the average scores are adjusted for patient mix and mode of survey administration. A clustering algorithm then groups hospitals into five different star categories for each performance metric measured. Those star ratings are used to determine the hospital’s overall HCAHPS score—creating an easy-to-understand grade for patients to review.
Fig 1 Graphic from Definitive Healthcare’s Expert Premium Content platform. Current HCAHPS score averages sourced from the CMS Hospital Compare update as of April 2019.
Rural hospitals command top 20 performance charts
As of July 2019, only 205 hospitals scored a 5-star HCAHPS rating and, of those, nearly 51 percent were classified as rural facilities according to Definitive Healthcare data. With lower patient volumes and little to no noise pollution, rural hospitals regularly excel in areas of doctor-patient communication, staff responsiveness, hospital cleanliness, and quiet inpatient stays.
This year, rural hospitals hold all top 20 positions on the list of hospitals with the highest cleanliness ratings. Three hospitals—Sanford Wheaton Medical Center (Wheaton, MN), Grover M. Hermann Hospital Division (Callicoon, NY), and Cavalier County Memorial Hospital (Langdon, ND)—share the top spot, with a 100 percent room and bathroom cleanliness score.
In addition, 19 of the top 20 hospitals with the highest doctor communication scores are rural. A small handful of those facilities—including Jackson County Hospital District, Mercy Hospital, Citizens Medical Center, and Hancock County Hospital—achieved the greatest possible rating, with 100 percent of patients answering “always” on the HCAHPS survey communication metric.
Fig 2 Graphic from Definitive Healthcare’s Expert Premium Content platform. Current data as of 07/10/2019.
More than that, rural hospitals are also outperforming urban facilities in terms of overall performance. A total of 14 rural hospitals are on the list this year for top 20 hospitals by overall HCAHPS rating—with the highest performers claiming as high as 99 percent patient recommendation.
Where urban hospitals are failing
According to the Definitive Healthcare database, a total of 76 hospitals scored a 1-star HCAHPS rating in 2019 and 66 of those—almost 87 percent—were classified as urban hospitals. In areas where rural hospitals are flourishing, urban facilities are floundering. Hospitals in large, urban regions consistently rank lower in provider communication, staff responsiveness, hospital cleanliness, and noise-related performance metrics.
This year, 18 of the bottom 20 hospitals by hospital environment metrics and discharge responses are in urban areas. Only about one-quarter of patients who stayed at Los Angeles Community Hospital (Los Angeles, CA) felt that the area around their room was always quiet at night. About the same amount—only 27 percent—of Glendora Community Hospital’s (Glendora, CA) survey respondents strongly agreed that they understood their care after being discharged from the hospital.
Fig 3 Graphic from Definitive Healthcare’s Expert Premium Content platform. Current data as of 07/10/2019.
Urban hospitals also rank lower than their rural counterparts on communication and responsiveness HCAHPS survey questions. Only 33 percent of patients who stayed at Mountain’s Edge Hospital (Las Vegas, NV) reported that they “always” received help as soon as they needed it. Los Angeles Community Hospital had just over half of their patient survey respondents indicate that doctors or nurses “always” communicated well—compared to the 100 percent ratings that patients reported at some rural hospitals.
While the contrast between HCAHPS performance by region may highlight certain areas where urban hospitals could improve their patient satisfaction, it’s also important to consider the nature of the performance assessment. The HCAHPS survey is an important quality metric in measuring hospital care and conduct, but its scoring system inherently disadvantages some facilities.
Urban hospitals serve larger patient populations and are naturally subject to greater amounts of noise pollution. Rural hospitals, by comparison, tend to have higher HCAHPS scores because they can more easily accommodate the needs of a smaller patient population, and allocate a greater amount of time and resources to each patient.
Large urban hospitals also serve some of the most vulnerable populations, where practitioners are more likely to encounter patients who don’t speak English as a first language—or, in some cases, at all. This can have a profound impact on HCAHPS communication scores and increase the disparity between those at the top and those at the bottom of the performance charts.
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