Is it easier for small hospitals to land a 5-star patient experience rating?

Patients are more likely to give a five-star rating for patient experience to hospitals that don't offer common services such as emergency care and intensive care, according to a study published in JAMA Internal Medicine on Monday.

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Hospitals with complex services are more likely to receive lower ratings

Researchers for the study analyzed the 2014 CMS patient experience ratings for 2,798 hospitals.

They found that, of those hospitals, 150 had received an average five-star patient experience rating. According to the researchers' analysis, these hospitals were 84% to 92% less likely than others to offer intensive care, cardiology, neurology, or emergency services.

The top-rated hospitals were also more likely to treat patients with fewer health issues, according to the study. The five-star hospitals performed a smaller selection of heart procedures and gastrointestinal procedures than hospitals that received a lower rating.

Star ratings aren't everything

Zishan Siddiqui, lead author of the study and a researcher at Johns Hopkins School of Medicine, explained, "Patient experience performance ratings are a relationship between communication and responsiveness needs of the patients and how well the hospitals perform to meet these needs." That could be why hospitals that offer fewer services receive higher patient experience ratings, Siddiqui said.

"If a hospital has patients only with simpler communication and responsiveness needs," such as hospitals that treat patients who require less complex care, "they may meet these needs without necessarily performing at a higher level," Siddiqui said. "The five-star hospitals appear to get higher scores because they are more often taking care of patients with simpler needs."

By offering fewer services, five-star hospitals can "offer more individual attention to patients," which can also impact their patient experience scores, according to Karl Bilimoria, a researcher at Northwestern University Feinberg School of Medicine.

But according to Anupam Jena from Harvard Medical School and Massachusetts General Hospital, patient experience ratings are often "important driver[s] of where patients receive care," which means that patients who search only for five-star hospitals might find that the service they need is not available at the smaller, five-star centers. 

As such, Siddiqui suggests that patients consider more than a hospital's star rating when they research facilities for complex care. "Hospital patient experience rating systems in general should be just one of many hospital metrics patients should look at when selecting hospitals," he said. "This is especially true for patients with multiple medical problems and chronic illness. They are much less likely to receive comprehensive services when admitted" (Bean, Becker's Hospital Review, 6/10; Rapaport, Reuters, 6/10).

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