Want to Draw Patients to Your Hospital? Make It Look Like a 5-Star Hotel
Hospitals are increasingly competing for patients on the basis of amenities such as private rooms, beautiful lobbies, magnificent views, and hotel-style room service. As a recent commentary in the New England Journal of Medicine points out, the relationship between these amenities and the clinical quality of care is questionable. Yet patients are being drawn to hospitals that offer such pluses, while generally ignoring data about a hospital's mortality, complication and readmission rates. Thus hospitals have an incentive to spend more on their facilities and less on quality if they want to attract well-insured patients.
The mantra of reform is that everything must be "patient-centered." Patient satisfaction with hospital care is a prominent component of Medicare's Hospital Compare website, and the Centers for Medicare and Medicaid Services (CMS) is expected to use HCAHPS, its standardized patient experience survey, in the "value-based" hospital purchasing program authorized by the Affordable Care Act. The question is whether the patients who fill out these surveys are more influenced by a hospital's intangible features than by its quality of care. A recent analysis of patient satisfaction data across the nation showed that it poorly correlated with hospital quality.
The NEJM article points out that after UCLA Medical Center was rebuilt (at a cost of $829 million) with a long list of amenities, the portion of patients who said they'd recommend the hospital to family and friends jumped from 71 percent to 85 percent. Had the quality of care improved? Considering that most of the staff was the same, that's doubtful.
The authors, who hail from UCLA and the RAND Corp., also cite their own research on where patients with pneumonia sought care in the Los Angeles area from 2000 to 2004. It turns out that, while the patients didn't necessarily choose the closest hospital, the facilities they picked did not have the lowest risk-adjusted mortality rates. Instead, they tended to favor hospitals that had the most amenities. This was also true of patients who'd had heart attacks and might have been expected to be more interested in the quality of care.
Another study found that doctors collude with patients in these inappropriate choices. Surveyed physicians said they placed considerable weight on the patient experience in hospitals, along with their technology, clinical facilities and staff. Nearly a third of primary-care doctors said they'd go along with a patient's request to be treated at a hospital with more amenities even if its clinical quality was inferior to that of other institutions.
What all of this suggests is that our system is already patient centered, but in exactly the wrong way. To please patients, many physicians will turn a blind eye to their own knowledge of a hospital's quality. And hospitals will invest precious resources in private rooms and hotel-level meals that could have gone into improving quality and protecting patients from medical errors.
What are we to say about a system that encourages such egregious decisions? It's a system in which business motives have taken precedence over patient well-being, where health has taken a backseat to profits. It will be interesting to see whether the reform campaign can change a mindset so deeply entrenched in our system.
Image supplied courtesy of Flickr.
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