Learning about Regional Health Systems

This morning we went out to the Rapid City Regional Medical Center to learn about rural regional health care systems so we would have something to compare to our experience at our urban academic medical center. I realized that something was different when the VP of Medical Affairs (who was also a captain in the Navy and the police force) came in to lead part of our tours.

As we wandered through their newly updated hospital floors, we wondered about the impetus for changing the patient rooms. Patient satisfaction, he said. But if you're the only regional medical center in the area, we wondered, why would you have an incentive to make things better since patients have no choice for where to go? Because the right thing to do, he said, and there are new Medicare incentive payments for hospitals that get the highest patient satisfaction ratings.

I had heard about these ratings before and our own hospital was going through similar discussion to try and figure out how to raise our outcomes in things like appropriate antibiotic prescriptions, prompt removal of urinary catheters and preventing hospital readmissions. But I had never heard -- or may simply just not know -- what efforts are being made to improve patient satisfaction. In reality though, the actual numbers for Rapid City are comparable to the University of Chicago for patient satisfaction. What was most strikingly different was that the board at Rapid City was clearly making capital investments to improve the patient experience on the hospital floors -- moving the nurses out of the hospital wings, incorporating better televisions in the rooms, and so on, whereas I suspect that the changes to improve patient satisfaction in other institutions may be a lot more subtle. So in the end, while all hospitals are being faced with figuring out how to handle the new quality-based reimbursement schemes from Medicare, what each hospital chooses to focus on and emphasize in that effort is going to be very different.

As we walked on to the next floor to see the new e-ICU suites (with the monitors outfitted to allow specialists from Sioux Falls to monitor patient codes), a classmate commented that it wasn't exactly fair for hospitals or physicians to be graded on patient satisfaction since satisfaction can so often be based on such arbitrary things rather than actual improved outcomes of care. And it's true. However, seeing the changes that are moving forward in Rapid City for care that improves the patient experience, I wonder whether what we saw really did demonstrate that the renewed focus on patient satisfaction may do some good for patients, at least in this part of the country.