In a recent report, the Medicare Payment Advisory Commission (MedPAC) identified the common traits of the nation’s poorly-performing hospitals (just under two percent – or 112 – were identified as poorly performing). These are traits that have a big impact on hospital financial performance and should be understood by all hospitals – even if they aren’t poorly performing currently.
1. Low occupancy. MedPAC found that many of the poorly-performing hospitals have occupancy rates of under 50 percent. Of the 112 singled out for poor performance, about half are rural hospitals and half are urban. Those urban hospitals on average have 138 beds – serving only 50 patients on any given day – and the rural hospitals have an average of 78 beds, with only 23 patients on any given day.
Low occupancy was a defining feature of the 17 acute care hospitals that closed in 2012, noted MedPAC, which also acknowledged that their low occupancy may also have been driven by other factors.
The hospitals that closed that year on average had slightly higher readmission and mortality rates and lower average quality scores for three measures of cardiac care. Six of the 17 had some of the lowest patient satisfaction ratings in the country, based on the proportion of patients saying they would “definitely not recommend” the hospital.
2. Risk-adjusted hospital-wide readmissions rates in the bottom 10 percent. While readmissions have been declining nationally, at the 112 hospitals singled out by MedPAC, readmissions were persistently high, even when accounting for their likely higher-risk patient populations. Their all-condition mortality rates are 20 percent higher than the national average.
High readmissions suggest a lack of care coordination with other healthcare partners, poor communications with patients and likely mean looming Medicare payment penalties, which can make it harder to invest in technologies and strategies to tackle the problem.
3. Patient dissatisfaction. Scores for patient experience surveys at the poorly-performing hospitals were in the bottom 10 percent. A high percentage of patients said they who would not recommend the hospital (or a low percentage of patients said they who would recommend the hospital) and patients gave these hospitals a rating of six or lower on a 10-point scale,.
With more patients paying more out-of-pocket for healthcare, a pleasant experience can make a big difference in their opinion of their care at the hospital, and potentially their outcomes, MedPAC noted in its report. Even simple things noise reduction, outdoor gardens and friendly staff offering customized discharge instructions and home follow-ups can go a long way.