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"Patients come here for excellent care. What they also want is to bne cared about."
Making the Grade
Hospital report cards ultimately may determine where patients go for care

 
Dan Wassilchalk, director of performance improvement, welcomes the new barometers of patient satisfaction.
A new national "report card" that would make health care quality information accessible to the public is in the works, and this one likely will put a renewed emphasis on a continuing theme: service excellence.

That is because this report card will reveal not just how hospitals stack up in clinical outcomes but also how they compare in patient satisfaction.

Hospital report cards have been in place in many states, including Maryland, for more than a year. For the most part, they have focused on clinical or financial performance. Few have reported on patient satisfaction. But now, as part of a pilot project initiated by the Centers for Medicare & Medicaid Services (CMS), patients treated in hospitals in three states-Maryland, Arizona and New York-will be asked to rate their experience with care. If the pilot test goes well, the national report card should roll out in fall 2003, with results released sometime in 2004.

"This will be the first time that patients will be able to make choices based on hospital-specific, patient satisfaction data," says Dan Wassilchalk, director of performance improvement at Hopkins Hospital. And, he adds, key groups like employers "also will be watching closely to see where they may channel employees and their health plans."

A core group of about 20 hospitals in the three states (none of Hopkins' three hospitals are among the core group) will provide 500 patients each for the test pilot. All other hospitals will provide 50 patients each, on average. Participation is mandatory for all Maryland hospitals and voluntary for those in Arizona and New York. The patients, all of whom were discharged between Nov. 1, 2002, and Jan. 31, 2003, will fill out a "Patient Experience of Care" survey this month, rating hospitals in areas such as coordination of care, communication of information, respect for values, and physical comfort.

Hopkins Hospital has long collected information on patient satisfaction. "Overall mean scores across the Health System have gone up and down," says Renee Demski, director of operations integration for the Health System. "Our challenge is that we need to continue to work on patient satisfaction to improve perceptions of the total patient care experience." Service excellence, she says, is what drives patient satisfaction. "We know that patients come here for excellent care. What they also want is to be cared about."

Hopkins Hospital received its first report card early in 2002 when the Maryland Health Care Commission (MHCC) debuted its Hospital Performance Evaluation Guide, which rated hospitals' clinical outcomes performance as opposed to patient satisfaction. For the most part, says Wassilchalk, "Hopkins Hospital performed 'as expected' [a report card category] when length of stay and readmission rates were compared to other Maryland hospitals." MHCC's 2003 Guide, which will come out this month, will rate hospitals on the care they deliver for patients with congestive heart failure and pneumonia.

CMS will release general results of the pilot national report card in July. The pilot is blinded, so specific hospitals will not be mentioned by name. But when the project goes national, hospitals will be identified and all materials will be put in the public domain.

Hospital report cards reflect a nationwide movement to improve health care quality by making providers publically accountable. It's a trend that Wassilchalk embraces, because patient satisfaction, employee satisfaction and patient safety are Hopkins priorities. "There will be no more saying that hospitals are protected, or that it's confidential, or that quality health care can't be measured," he says. "These report cards will make providers accountable to patients, payers, constituency groups and the government. We need to welcome these programs as one approach to inform the consumer, validate our performance and identify opportunities for improvement."

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