Big vs Small...PO Day 340

Exerpted from an article

By Zack Budryk

"The Centers for Medicare & Medicaid Services' patient satisfaction rating system puts large urban hospitals at a distinct disadvantage compared to their smaller urban/suburban counterparts, according to research published in the Journal of Hospital Medicine. CMS regards improving patient satisfaction scores as a major step in the transition from fee-for-service healthcare to a value-based model, and post-Affordable Care Act, scores are more heavily weighted in the formula the agency uses to determine reimbursements. Despite this, a recent report indicates overall patient satisfaction is nearing a 10-year low even as demand for services increases. Researchers, led by Randall Holcombe, M.D., chief medical officer for cancer at Mount Sinai Health System in New York City, studied survey data from 934,800 patients at 3,907 hospitals, and found that regardless of the organization's location, English as primary language and hospital size were major predictors of patient satisfaction. Overall, patients gave the lowest scores in densely populated regions such as the District of Columbia, California, New Jersey and Maryland. Conversely, more sparsely populated areas such as South Dakota, Maine, Vermont and Louisiana had higher scores, according to Holcomb." And yet...In Post 335 I reported how some of the big, well known hospitals are wanting to establish volume requirements for CMS to pay for the top ten most difficult surgical procedures. Their opinion is that large facilities where high volume surgeons prevail have better outcomes. And that may be true but it obviously does not translate to patient satisfaction. And patient satisfaction is a large factor in rating hospitals. Of course, being able to communicate is always an issue but can you imagine being sick or injured and not able to talk to the doctors or nurses? But how would that be different at a smaller rural facility than at a large urban hospital? I would think the large hospital would be more likely to have an interpreter available or even staff members who speak the same language. It has to be the size and imtimacy of the smaller hospital that tips the scale in their favor. I like my small local hospital. It has the advantage of being part of a large hospital system but is in the just fewer than 100 beds category. I know my particular procedure is probably not done there with the frequency at thelarge  city hospital 75 miles from here. I could have sought care there. But the proof is in the pudding, all's well that ends well, and I hope the Affordable Care Act and the need to  limit services does not put the small, community hospital out of buisness.