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Safety-Net Hospitals: Other Hospitals Score Similarly on Patient Experience

Safety-Net Hospitals: Other Hospitals Score Similarly on Patient Experience We appreciate the analysis of Chatterjee and colleagues.1 The improvement trend in patient experience at safety-net hospitals (SNHs) between 2007 and 2010, despite lower overall achievement of SNHs vs non-SNHs, is a valuable contribution to the literature. Including patients' experience into the Inpatient Quality Reporting Program of the Centers for Medicare & Medicaid Services (CMS) increased visibility of patient experience at SNHs and other facilities across the country and helped facilitate the quality improvements the authors note.2 The application of these findings to value-based purchasing (VBP), however, is concerning. The authors' methodology inaccurately portrays the hospital VBP program.3 First, hospital VBP rewards achievement, improvement, and consistency, not achievement alone. Applying the correct methodology to determine VBP scores for patient experience using CMS's “dry run” data, SNHs perform similarly to other hospitals—24% of SNHs appear in the top quartile vs 25% of non-SNHs.4 (Note: SNHs are defined as a hospital with a share of Medicaid days greater than 1 standard deviation above the state's Medicaid mean, in a county with a poverty rate greater than 1 standard deviation above the state's mean county poverty rate, or in the top decile nationally for reported “IPPS [Inpatient Prospective Payment System] bad debt” as a percentage of total revenue [a measure of uncompensated care].) Second, in Table 4, Chatterjee et al1 compare SNH performance in 2010 with median hospital performance in 2010. This comparison is not significant for VBP and does not reflect the potential for hospitals to score well or poorly in the program. Third, our discussions with physicians, other health care providers, and hospital leadership suggest incorporation of patient experience into VBP has increased focus on what matters most to patients in receiving high-quality care. Value-based purchasing was not established in statute until March 2010. Thus, neither the study by Chatterjee et al1 nor the “dry run” captures this effect. An evaluation of hospital performance over the first years of the VBP program is needed. We also challenge the assumption that patient experience of care cannot differentiate quality of care delivery. A fundamental tenet of patient-centered care is how patients experience care.5 Patient experience is not a proxy for other outcomes of interest, such as mortality or quality of life. It is itself an outcome. The CMS highly values patient experience and has incorporated it and other measures that relate to the National Quality Strategy into VBP. We appreciate the authors' recognition of the challenges CMS faces in implementing national policy that improves quality and reduces disparities. Early data suggest that we are succeeding for patient experience. However, continued monitoring and on-the-ground support through Medicare's Quality Improvement Organizations, Community Care Transitions Program, and other improvement funding is critical to ensuring that our most vulnerable patients receive high-quality care and we close gaps in disparities. We look forward to continued engagement and support for safety-net providers to improve the care delivered to the patients they serve. Back to top Article Information Correspondence: Mr VanLare, Centers for Medicare & Medicaid Services, 7500 Security Blvd, Woodlawn, MD 21244 (jordan.vanlare@cms.hhs.gov). Funding/Support: The CMS supported this research. Role of the Sponsors: The funding agency did not influence the design, analysis, or writing of the manuscript. Disclaimer: This manuscript represents the views of the authors and not necessarily the CMS. Additional Contributions: Elizabeth Goldstein, PhD, and William Lehrman, PhD, of the CMS provided critical review of the manuscript. References 1. Chatterjee P, Joynt KE, Orav EJ, Jha AK. Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med. 2012;172(16):1204-121022801941PubMedGoogle ScholarCrossref 2. Centers for Medicare and Medicaid Services. Report to Congress: National Impact Assessment of Medicare Quality Measures. Baltimore, MD: Centers for Medicare and Medicaid Services; March 2012 3. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; hospital inpatient value-based purchasing program: final rule. Fed Regist. 2011;76(88):26490-2654721548401PubMedGoogle Scholar 4. Centers for Medicare & Medicaid Services. National Provider Call: Hospital Value-Based Purchasing Dry Run of the Fiscal Year 2013 Hospital VBP Program. 2012. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/HVBPNPCSlides022812-.pdf. Accessed July 24, 2012 5. Berwick DM. What ‘patient-centered’ should mean: confessions of an extremist. Health Aff (Millwood). 2009;28(4):w555-w56519454528PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Safety-Net Hospitals: Other Hospitals Score Similarly on Patient Experience

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Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/jamainternmed.2013.2158
Publisher site
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Abstract

We appreciate the analysis of Chatterjee and colleagues.1 The improvement trend in patient experience at safety-net hospitals (SNHs) between 2007 and 2010, despite lower overall achievement of SNHs vs non-SNHs, is a valuable contribution to the literature. Including patients' experience into the Inpatient Quality Reporting Program of the Centers for Medicare & Medicaid Services (CMS) increased visibility of patient experience at SNHs and other facilities across the country and helped facilitate the quality improvements the authors note.2 The application of these findings to value-based purchasing (VBP), however, is concerning. The authors' methodology inaccurately portrays the hospital VBP program.3 First, hospital VBP rewards achievement, improvement, and consistency, not achievement alone. Applying the correct methodology to determine VBP scores for patient experience using CMS's “dry run” data, SNHs perform similarly to other hospitals—24% of SNHs appear in the top quartile vs 25% of non-SNHs.4 (Note: SNHs are defined as a hospital with a share of Medicaid days greater than 1 standard deviation above the state's Medicaid mean, in a county with a poverty rate greater than 1 standard deviation above the state's mean county poverty rate, or in the top decile nationally for reported “IPPS [Inpatient Prospective Payment System] bad debt” as a percentage of total revenue [a measure of uncompensated care].) Second, in Table 4, Chatterjee et al1 compare SNH performance in 2010 with median hospital performance in 2010. This comparison is not significant for VBP and does not reflect the potential for hospitals to score well or poorly in the program. Third, our discussions with physicians, other health care providers, and hospital leadership suggest incorporation of patient experience into VBP has increased focus on what matters most to patients in receiving high-quality care. Value-based purchasing was not established in statute until March 2010. Thus, neither the study by Chatterjee et al1 nor the “dry run” captures this effect. An evaluation of hospital performance over the first years of the VBP program is needed. We also challenge the assumption that patient experience of care cannot differentiate quality of care delivery. A fundamental tenet of patient-centered care is how patients experience care.5 Patient experience is not a proxy for other outcomes of interest, such as mortality or quality of life. It is itself an outcome. The CMS highly values patient experience and has incorporated it and other measures that relate to the National Quality Strategy into VBP. We appreciate the authors' recognition of the challenges CMS faces in implementing national policy that improves quality and reduces disparities. Early data suggest that we are succeeding for patient experience. However, continued monitoring and on-the-ground support through Medicare's Quality Improvement Organizations, Community Care Transitions Program, and other improvement funding is critical to ensuring that our most vulnerable patients receive high-quality care and we close gaps in disparities. We look forward to continued engagement and support for safety-net providers to improve the care delivered to the patients they serve. Back to top Article Information Correspondence: Mr VanLare, Centers for Medicare & Medicaid Services, 7500 Security Blvd, Woodlawn, MD 21244 (jordan.vanlare@cms.hhs.gov). Funding/Support: The CMS supported this research. Role of the Sponsors: The funding agency did not influence the design, analysis, or writing of the manuscript. Disclaimer: This manuscript represents the views of the authors and not necessarily the CMS. Additional Contributions: Elizabeth Goldstein, PhD, and William Lehrman, PhD, of the CMS provided critical review of the manuscript. References 1. Chatterjee P, Joynt KE, Orav EJ, Jha AK. Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med. 2012;172(16):1204-121022801941PubMedGoogle ScholarCrossref 2. Centers for Medicare and Medicaid Services. Report to Congress: National Impact Assessment of Medicare Quality Measures. Baltimore, MD: Centers for Medicare and Medicaid Services; March 2012 3. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; hospital inpatient value-based purchasing program: final rule. Fed Regist. 2011;76(88):26490-2654721548401PubMedGoogle Scholar 4. Centers for Medicare & Medicaid Services. National Provider Call: Hospital Value-Based Purchasing Dry Run of the Fiscal Year 2013 Hospital VBP Program. 2012. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/HVBPNPCSlides022812-.pdf. Accessed July 24, 2012 5. Berwick DM. What ‘patient-centered’ should mean: confessions of an extremist. Health Aff (Millwood). 2009;28(4):w555-w56519454528PubMedGoogle ScholarCrossref

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Mar 11, 2013

References