Background:

Starting in October 2012, Medicare will base part of its hospital payments on how hospitals perform on patient experience metrics. Given the inpatient expertise of hospitalists and their 24/7 presence, increasing hospitalist staffing may be one approach to enhancing patient satisfaction.

Methods:

Using 2009 national Medicare data we examined the association between hospitalist staffing and patient satisfaction scores. To determine hospitalist staffing, we estimated the proportion of medicine inpatients cared for by hospitalists at each included hospital. We used a well–validated approach that classifies general internists with at least 90% of their evaluation and management (E&M) billings from inpatient care to be a hospitalist. Patient experience metrics were derived from the Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey (Table). In multivariable regression, we adjusted for potential confounders, including percent Medicaid patients, hospital size and teaching status, location, presence of a medical intensive care unit, and nurse staffing.

Results:

Our cohort included 132,814 patients’ index medicine admissions at 2,843 hospitals in 2009. Overall, 44% of general medicine admissions were cared for by hospitalists. At 17% of hospitals no medicine admissions were cared for by hospitalists; at 4% of hospitals all medicine admissions were cared for by hospitalists. In multivariable analyses, compared to hospitals with low hospitalist staffing, hospitals with high hospitalist staffing had modestly higher patient satisfaction scores across most dimensions of care (Table). For example, among hospitals in the highest tertile of hospitalist staffing, 80.4% of patients reported being satisfied with discharge compared to 77.6% in the lowest tertile (P–value <0.001).

Conclusions:

Hospitals with higher levels of hospitalist staffing have modestly higher performance on patient experience scores across most dimensions of care, including satisfaction with discharge planning. Understanding why hospitals with more hospitalists have higher patient satisfaction is important for clinical leaders hoping to improve performance on these metrics.

Hospital–level Association between Hospitalist Staffing and Patient Satisfaction, Adjusted

Dimension of Care Patient Satisfaction Score P–value
Hospitals in Highest Tertile of Hospitalist Staffing Hospitals in Lowest Tertile of Hospitalist Staffing Difference (Highest minus Lowest Tertile)  
Would Recommend 68.6 64.8 3.8 <0.001
Overall Satisfaction 65.6 62.7 2.9 <0.001
Discharge 80.4 77.6 2.8 <0.001
Nursing Services 62.8 61.4 1.4 <0.001
Communication with Nurses 75.4 74.1 1.3 <0.001
Pain Control 68.8 67.7 1.2 <0.001
Quiet 59.4 58.3 1.1 0.0012
Communication about Medications 58.3 57.4 0.9 <0.001
Clean 68.5 68.0 0.6 0.04
Communication with Doctors 80.4 80.5 0.0 0.91
Note: Numbers are rounded, so the numbers in the difference column do not always equal rounded patient satisfaction scores for hospitals in the highest tertile of hospitalist staffing minus rounded patient satisfaction scores for hospitals in the lowest tertile of hospitalist staffing.