Patient satisfaction at the 75th percentile

This week we celebrated impressive improvements in Community General Hospital's patient satisfaction scores . . . across the board.

There were free sundaes in the cafeteria on Wednesday, and Chris Stryker, Chief Nursing Officer, and her Directors Nancy Thompson, Lyn Pittinger, and Cathy North brought ice cream to night staff in various departments.

The graph shows Community's overall patient satisfaction rating, as posted in the hospital this week.

The Press Ganey survey scores (second quarter, 2010) show patients overall rating of the hospital at 86.4%, a statistically significant improvement over previous scores. That score puts Community at the 75th percentile for hospitals of our size nationally and for hospitals in our Central New York comparison area.

The overall rating reflects improving patient satisfaction in all areas, including these statistically significant gains:

▪ Satisfaction with nursing care and communication -- 89.9%, up over two percentage points
▪ Satisfaction with doctors care and communication -- 88.7%, up over two points
▪ Satisfaction with the handling of personal issues -- 87.0%, up over two points
▪ Satisfaction with hospital accommodations -- 81.4%, up over four points

We've seen the improvements coming as we track the changes from week-to-week and quarter-to-quarter.

Improved patient satisfaction has also been evident in the HCAHPS* scores the federal government posts on its Hospital Compare website. I talked about the HCAHPS improvements in employee meetings last May.

It's great to know that patients see improved value from our caring and in our hospital environment. Congratulations to Community's employees, to our management team, and to our medical staff.

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* HCAHPS stands for "Hospital Consumer Assessment of Healthcare Providers and Systems." HCAHPS track and report the opinion of Medicare patients at hospitals across the nation.

Our employee meetings

As I do from time to time, I held ’round-the clock meetings for employees on May 6. Naturally, a lot of the discussion focused on the impact of the federal health care reform legislation as it affects hospitals, as well as on the status of Community General Hospital's merger discussions with Crouse Hospital.

Health care reform legislation

I summarized the effects of the health care reform legislation – admittedly, at a very high level – on consumers, hospitals, and other organizations. For consumers, health care coverage will become more available, and an estimated 30 million individuals could be added to insurance rolls. Individuals will not be excluded from purchasing health insurance because of pre-existing health conditions, nor will there be any lifetime caps on what insurance pays for care and treatment. Adult children, up to the age of 26, will be able to have coverage under their parents’ insurance plans. This information has been generally well-covered in the news media.

I also talked about the impact of health care reform legislation on hospitals, specifically about the $196 billion reduction in Medicare and Medicaid payments to hospitals over the next ten years. There will be new taxes on medical devices and on brand-name pharmaceuticals ($31 billion over ten years), as well as the new taxes on health insurance coverage itself ($57 billion during the period). These are examples of increased costs hospitals will have to pay for the goods and services they buy.

The hospital association has translated the $196 billion nationwide reduction into the impact on each hospital in New York State. Because of the new legislation, the four hospitals in Syracuse, NY, will receive $424 million less from Medicare and Medicaid over ten years. These are huge numbers, and they are hard to imagine in the current context.

These reductions in revenue are expected to be offset to some extent by revenue from individuals who will have health coverage, thanks to the legislation. It is very unlikely, however, that the revenue from the newly insured will come close to offsetting the reduced hospital payments that are forecast.

Overall the health care reform law will be a transformative force affecting the way health care is provided in our society.

Our merger talks

In this context I discussed the merger talks currently underway between Community General and Crouse Hospitals. I compared the forces acting on Community (such as, higher state taxes, the needs of physicians and medical groups, and pension costs) with some of the forces affecting Central New York generally (such as, flat population growth, an aging population, and Medicaid cutbacks). Recognizing these forces and anticipating the impact of federal health reform legislation, last January Community and Crouse entered an agreement to plan a merger, if feasible.

Moody’s, the financial analysis company, recently predicted that, as a result of federal legislation, non-for-profit hospitals will find it more difficult to borrow funds and that more hospitals will look for opportunities to consolidate.

Community and Crouse are, in fact, considering the advantages of creating a larger hospital that operates two campuses. The advantages could include the better ability to work with physicians, potentially better access to capital, more efficiency, and the ability to avoid duplicate investments. In interviews with consultants earlier this year, physicians from both hospitals suggested various ideas, and the consultants have been considering these. The consultants are getting close to a recommendation for both hospitals to consider.

Assuming both hospital boards adopt a structure recommended by the consultants, there will still be a number of steps remaining before the merger process is done. These include implementation planning with clinicians, filing a Hart Scott Rodino document with the Federal Trade Commission, and preparing a Certificate of Need (CON) application for New York State. In addition, both hospitals would have to complete “due diligence,” a process in which each hospital examines the other’s business in detail, considering such things as financial performance, business contracts, tax issues, pension obligations, property ownership, etc. The time frame for these activities could be another year or so.

Our financial performance

I also reviewed Community's financial performance through the first quarter of 2010.

I was pleased to report that through March, Community is operating in the black and on-budget (see the chart below). This is significantly better financial performance than we experienced in 2009 in the first quarter.

Patient satisfaction

I discussed patient satisfaction and showed how Community's most recent HCAHPS scores – as self-reported by Medicare patients – have improved in every category.

The HCAHPS survey measures the percentage of Medicare patients who report that nurses and doctors “always” communicate well, that their pain is “always” well-controlled, and that their rooms are “always” well-cleaned. Community does well in comparison with other Syracuse hospitals – we have the highest scores in three of ten categories and the second highest scores in another five categories. And . . . Community's HCAHPS scores improved in the most recent 12-month period (see the chart, below).

Improvements to come

I talked about improvements being made to patient rooms on several units. The sixth floor renovation (orthopedics) has been completed, and room improvements are underway on Three West. Furthermore, we have begun to update rooms on Four West and, when finished in late summer, the patients and staff from Two West will relocate to Four West to take advantage of the updated and larger rooms. Following that, we will make improvements to the GYN rooms on Two East.

The new health information exchange

Community will become the first hospital in Syracuse this year to link to the health information exchange (HIE) being developed by the Health Advancement Collaborative of Central New York (HAC-CNY).

The HIE will initially link all four Syracuse hospitals, through the Internet, with five primary care physician groups, representing several hundred physicians. By next year doctors and hospitals on this fledgling network will be able to exchange patient-specific data with the consent of the patients themselves. As more physician practices join the exchange, HAC-CNY will link to other networks through the State Health Information Network of New York (SHIN-NY). The idea is to make individual patient information readily available to any of that individual’s caregivers. Naturally, there are demanding security and patient privacy requirements for this to function.

Employees had a number of questions and suggestions during the meetings, and I appreciated the opportunity to speak with so many of you.

Not me

Several people have asked if the Post-Standard made the mistake last week in its story A health report card, about the HCAHPS survey results. The newspaper attributed Tom Quinn’s comments to the marketing director at Cortland Regional Health Center.

The answer is no, the newspaper did not make a mistake. There is another Tom Quinn, and he works in Cortland, NY.

There are many namesakes, and if you Google “Tom Quinn,” you find pages and pages of us. Tom Quinn, the astronomer. Tom Quinn, the fictional case officer in Britain’s MI5. Tom Quinn, author. Criminal defense lawyer. Film actor.

As a 14-year old, I attended a junior seminary in Pennsylvania. One day after class, I discovered that my name was crudely scratched in a corner of a blackboard. I pointed this out to the priest who taught us Latin. “I didn’t do that,” I sheepishly explained. “I know,” he said with a big grin. “It’s been there for years. Today that Tom Quinn is probably in jail.”

What they say

Community General Hospital was one of 132 hospitals nationwide that voluntarily participated in a patient survey undertaken by the federal government last year. The Centers for Medicare and Medicaid (CMS) conducted a pilot project involving 61 hospitals in New York, 45 in Maryland, and 26 in Arizona.

CMS will use the project to develop a standard way of evaluating hospital performance by patients. When the project is finished, we can expect CMS to look for ways to link the how hospitals are paid to how well patients rate their care.

The CMS surveys were conduced on Community's medical-surgical patients who were discharged in December 2002 and January 2003. For obstetric patients, the sample was drawn from patients in the November 2002 and January 2003 period. Patients received a pre-survey letter, a mail-in questionnaire, and a thank you card. Those who did not return questionnaires received up to five follow-up telephone calls to improve the response. As a result, of the 900 Community patients who were surveyed, fully one-half responded (49.9%).

Patients were asked to score the hospital from 0 to 10 with 0 being the “worst possible” hospital experience and 10 being “best possible.” 35% percent gave Community a “perfect 10” and 63% scored “9 or 10.” Most people had very good experiences here, but surveys like this one help us focus on improving performance by using information from those who rated us less favorably.

The CMS survey results also suggest how we compare with other hospitals in the state and nation. For example, on the “worst possible/ best possible” question, 59% of the patients scored “9 or 10” among the 61 New York hospitals that participated.

We looked at another survey this week at a meeting of the Medical Executive Committee. That survey, conducted at a recent meeting of the Medical Staff, helps us understand physician opinion. This is a snapshot of the views of the doctors on whom we depend for patient referrals and medical management.

In all 52 physicians completed the survey, and they said the quality of physician care at Community is comparable to other hospitals – one-fifth reported it as “better.” Only 2% forecast a decrease in their work at Community with 23% saying they anticipate using Community more in the future.

One question asked: “Is Community's image in 2004 better, worse or the same as 2002?” In reviewing the results this week, one Department Chairman said he was pleased that 69% of the doctors think our image improved. “And I think that’s right,” he said. “Community is better.”

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.