Sophisticated and Powerful Consumers: How Transparency Will Change Hospitals

While patients have always been hospitals' consumers, provisions of the Patient Protection and Affordable Care Act paired with increased availability of provider data, ratings and reviews has left the patient more informed and engaged than ever before. Hospitals that adjust their transparency and delivery models to meet sophisticated consumers will fare better as healthcare reform unfolds.

Sources of consumer data
Between word-of-mouth, the CMS' Hospital Compare, HealthGrades and various consumer blogs, patients have seemingly infinite amounts of healthcare data available to them. David Woolwine, vice president of Learning and Organizational Development at Sentara Healthcare, an eight-hospital system based in Norfolk, Va., notes that patients have become more informed over the past few years and have taken a new role in care delivery as a result. "They know the ins and outs of healthcare now," he says. "They’ve looked at particular diagnoses and can participate in the delivery of their care. People look at quality and service ratings, blogs and all kinds of consumer comments. They are also asking more clinical questions," says Mr. Woolwine.

Many experts remain split on whether data, such as HCAHPS, word-of-mouth or word-of-mouse — such as blogs or online scores — drive patient decisions more. Before Mary Malone, MS, JD, became president of Malone Advisory Services, she worked at Press Ganey as a senior leader for more than 14 years. Ms. Malone says while data is reliable, patients may still focus on the personal nature of hospitals. "I might be a contrarian on this, but I think you might see a bigger emphasis on word of mouth," says Ms. Malone. "It seems clear that word-of-mouth is still the number one way we learn about our healthcare or select our physicians and hospitals," she says.

Word-of-mouth works both ways, helping or hurting a hospital's place with consumers along with its bottom line. "We recently had a client tell us of a situation where patients cancelled surgeries with a surgeon the hospital recently hired. An investigation found that patient comments on consumer sites — not medical sites — were negative. It turned out that the surgeon only had five ratings, but they were negative and it cost the hospital business," says John Luginbill, CEO of Indianapolis-based The Heavyweights, an agency that helps healthcare institutions drive patient volume.

Some feel that it takes more than comments on a website to influence the healthcare decisions of savvy consumers, however. "We now have an environment where patients and consumers are very sophisticated," says Stephanie Goldberg, MSN, RN, NEA-BC, senior vice president of patient care services and chief nursing officer at Hospital for Special Surgery (HSS) in New York City. "There is a lot of information out there and increased transparency. Consumers can go to a website and look at infection rates, HCAHPS data, nursing accreditations and more. In an age of transparency for consumers, it's important for organizations to keep their qualitative data at the highest level," says Ms. Goldberg.

The fine line between quality and amenities
One facet of consumer-driven healthcare that has gained momentum in recent years is the patient amenity, a broad term encompassing perks like back massages, scenic views and world-class food. Hospitals in areas with well-insured patients or markets where competition is fierce are more likely to compete through perks. Research has indicated that improvements in amenities cost hospitals more than improvements in quality of care — but improved amenities led to a greater effect on hospital volume.

This finding does not necessarily mean patients care more about perks than quality of care, according to John Romley, PhD, an economist and faculty member of the University of Southern California in Los Angeles. "It's very hard for patients to assess quality of care at hospitals. It may be easier for them to assess whether they will get a private room with good food and nice people," says Dr. Romley. Even if patients do understand hospital data, some may still be willing to trade a little bit of clinical quality for nicer amenities, says Dr. Romley.  

There is a fine line, however, between amenities and features of safety or quality. "One feature people focus on is the private, single room. I don't view that as an amenity," says Ms. Malone. "It's a safety feature." Ms. Malone says hospital perks are not merely hotel-like features intended to draw patients but are supported by research that shows features contribute to healing and improved outcomes. These include more natural light, in-room accommodations for family members, individual controls for temperature and light and noise reduction strategies. "I would make the argument that creating a really good patient experience — one that de-stresses the patient and makes them feel more comfortable — is a sign of quality care."

Executive and staff involvement in the patient experience
Executives may not always be in the nearest proximity to the patient bedside, but they can still ensure the hospital remains focused on patient satisfaction and experience. The practice of walking the halls and visiting patient rooms, or rounding, is commonly advocated by hospital leaders as a method to remain involved in patient experience. Mr. Woolwine says this practice, when widely implemented, is very effective at Sentara and helps executives check the pulse of the hospital. "We don't just visit with those patients having a challenging visit but patients all over the spectrum," he says.

Sentara has also introduced smaller measures to gauge patient desires, such as customized white boards in patient rooms that patients use to communicate with caregivers in sharing their unique wants or needs. "It basically has space for the patient to write two or three things that would make their stay more like home," says Mr. Woolwine. By specifically outlining this and other care information, the white boards help nurses and medical staff attune to patient needs, such as keeping the room bright or dim.

Leadership rounding is also a common practice at HSS. "We pay attention to every single letter and comment," says Ms. Goldberg. "I would say every minute of the day is spent on patient satisfaction and patient excellence. Our staff lives and breathes patient satisfaction data and we have different structures and committees in place to respond to that data," says Ms. Goldberg.

The hospital measures patient satisfaction through Press Ganey tools. Every patient is mailed a measurement tool, and HSS sees a very high response rate, according to Ms. Goldberg. Meetings and committee structures allow staff to craft short-term and long-term action plans, such as hourly rounding shifts or adjustments in the delivery of care model, in response to patient satisfaction data. "We respond to that data quickly," says Ms. Goldberg.

Awards and accreditations
Marketing may take a backseat to quality improvements, but the way in which a hospital markets its awards and accreditations still holds weight to consumers. Awards offered by agencies such as Thomson Reuters, U.S. News & World Report and HealthGrades are highly publicized by hospitals and are easy for consumers to understand. Healthcare accreditation, such as that of Magnet or the Joint Commission, is also telling of a hospital's quality of care. Many of these rankings or awards also overlap and build on one another. For instance, Magnet status is one criterion for hospitals to be recognized by U.S. News & World Report as the country's best.  

The American Nurses Credentialing Center has named HSS a Magnet institution, recognizing its excellence in nursing. Approximately 6.6 percent of registered hospitals have achieved this title. "In general, if a hospital is Magnet-accredited, the consumer recognizes the organization for excellent nursing care and quality outcomes," says Ms. Goldberg. Magnet accreditation also serves as a draw for patients, who may choose a Magnet institution over a hospital that is not Magnet-accredited, according to Ms. Goldberg.

Along with its appeal to consumers, the attributes of a Magnet-accredited hospital, such as staff participation in clinical decision-making, are attractive to nurses and distinguish HSS from other work environments. "Staff certainly seeks Magnet hospitals, so this designation is also effective as a recruitment strategy," says Ms. Goldberg. "The practice environment also supports nurses to remain at HSS, which only benefits the patient."

Sharing cost information and best practices
While healthcare reform does not require hospitals to post costs for common services until 2014, many providers are stepping in front of the deadline. Hospitals are making price information more transparent to both consumers and fellow providers.

Many healthcare experts say transparency on health prices will eventually eliminate large cost disparities between providers through competition, prompting many hospitals and providers to jump on board before reform's mandates. For instance, Spectrum Health Hospital Group in Grand Rapids, Mich., has posted prices online for approximately four years. About 1,000 visitors visit the site per month for price information alone, and the hospital also offers financial counseling services to help patients better understand the billing process. Last March, a Wisconsin bill went into law, requiring healthcare providers to disclose costs of the most commonly performed procedures in an effort to help consumers determine out-of-pocket costs and compare one provider to another.

Launched in Dec. 2010 by six organizations, the High Value Healthcare Collaborative is a project that compares data on quality, outcomes and cost among healthcare providers. The number of HVHC members has now expanded to 15, with organizations including Cleveland Clinic, Mayo Clinic, University of Iowa Health Care and UCLA Health System, among others. Under the arrangement, Dartmouth Institute for Health Policy and Clinical Practice coordinates data sharing and reports results back to each provider to inform the development of best practices and cost reduction.

Transparency in pricing has delved into payor territory, as legislators push for insurance companies to provide consumers with the costs of services at hospitals. In April, a Missouri Senate bill would require payors to post prices online so consumers could simply type the service they need into a website and see its cost at various medical facilities. The bill's author, Sen. Rob Schaaf (R.-St. Joseph) is a physician who says the bill would increase cost transparency and bring competition into the industry.

Related Articles on Consumers and Healthcare:
Consumer Access to Hospital Data Places High Expectations on Facilities
More Hospitals Publicizing Prices, Expanding Financial Counseling Services
The Importance of Patient Experience for Hospitals: Why it Pays to Excel

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