Patient Satisfaction Correlates with Direct Cost per Case for Hospitals
Andre D. Kumar MD, Monisha Shah MPH, and Lisa Shieh MD, PhD
1Department of Medicine, Stanford University Healthcare, Stanford, CA 94301
Background: Patient satisfaction scores are directly tied to hospital reimbursement via Medicare. The HCAPS assessment is a national survey that measures patient satisfaction and is used to determine reimbursement rates. It is unknown if there is a correlation between hospital expenditures per case and overall patient satisfaction. In theory, hospitals that emphasize the patient’s experience and satisfaction may also have higher overhead and direct cost per case.
Design/Methods: Patient satisfaction scores from the HCAPS survey were obtained from 276 academic hospitals registered with the University HealthSystem Consortium (UHC) between 1/2014 and 12/2014. Hospitals were excluded if no HCAPS data were available. Overall patient ratings of their hospital, as measured through HCAPS, were correlated with the cost per case. Mean and standard deviation (SD) were calculated for cost per case and hospital ratings. Hospitals were further categorized based on their rating as high performers (1 SD above the mean HCAPS rating), average performers (within 1 SD of the mean), or low performers (1 SD below the mean).
Results: 228 hospitals were included, with over 331,157 completed surveys (mean 1,452 per hospital) and an average response rate of 27%. Hospitals were ranked an average score of 74 out of 100 (standard deviation, SD, 7.78). The mean direct cost per case was $8,467. Patient satisfaction scores mildly correlated with increasing direct cost per case (r2=0.157; p<0.001). The mean costs per case for high (n=33), average (n=159), and low (n=36) performing hospitals were $11892, $8277, and $6165, respectively (p<0.001).
Conclusions: At academic centers, the mean direct cost per case mildly correlates with higher hospital ratings as defined by patient satisfaction surveys. Hospitals that outperform in terms of overall patient ratings have high direct costs per case.