WASHINGTON – Thought your hospital room was dirty? Did your nurse sometimes ignore you? If so, the hospital has a new reason to worry: Patient gripes soon will affect how much hospitals get paid by Medicare.

The Centers for Medicare and Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying scores from patient-satisfaction surveys to payments will result in better care.

But many hospital officials are wary, arguing the scores don’t necessarily reflect the quality of the care and are influenced by factors beyond their control.

Medicare has been publishing patient-satisfaction scores on its Hospital Compare Web site since 2008 but hasn’t used them to adjust payments.

Under CMS’ proposal, Medicare will withhold 1 percent of its payments to hospitals starting in October 2012. That money — $850 million in the first year — will go into a pool to be doled out as bonuses to hospitals that score above average on several measures. The agency is poised to release the final rule.

This may hurt hospitals in regions where patients tend to render less-than-glowing judgments. In the District of Columbia and New York state, only 59 percent of patients give their hospital experiences a top rating, lower than anywhere else except the Virgin Islands. Nationally, an average of 67 percent of patients give their hospitals a top rating.


Under the proposal, patient scores would determine 30 percent of the bonuses, while clinical measures for basic quality care would set the rest.

“These are hard scores to improve, and I think that’s why hospitals get frustrated,” said Dale Shaller, a Minnesota researcher who oversees the national patient survey database for the federal government. Hospitals argue that the scores should have less weight but nevertheless are trying to figure out how to improve their rankings.

No one is sure why hospitals in some regions fare more poorly than those in other parts. One theory: These hospitals treat lots of patients with multiple ailments, leading to worse reviews. CMS says it adjusts its ratings to take this into account.

Teaching hospitals and other large hospitals also get worse patient evaluations than do small community hospitals, some research shows.

District of Columbia hospitals lag on many of the specific questions. For instance, about two-thirds of recently discharged patients at George Washington University Hospital reported nurses always communicated well. That was 10 percentage points below the national average.

Chris Jordan, director of quality management at George Washington Hospital, said his hospital has been improving its patient ratings this year. “I can guarantee you that we’ll get better,” he said.


In New York City, three nationally known teaching hospitals — Beth Israel Medical Center, NYU Langone Medical Center and the Mount Sinai Medical Center — scored below average. Even New York-Presbyterian Hospital, which did better than average on its overall rating, still scored below average on specific questions.

“Because we have such cultural diversity, such literacy variability and such large and very complex hospitals, for us to always hit it out of the park is very difficult,” said Jaclyn Mucaria, a senior vice president at New York-Presbyterian.

James Merlino, chief experience officer of the Cleveland Clinic, which scores below average on seven of nine key patient-satisfaction questions, said doctors and nurses have done their own studies and concluded that very sick and depressed patients give skewed views.

For example, very ill patients are less likely to report that nurses check in on them every hour — even when logs prove they did, he said.

But low patient ratings often spring from real shortcomings, such as bad employee morale or bed shortages, said Jodie Cunningham, of Press Ganey, a company that administers the surveys for many hospitals.


Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.