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How Grumpy Patients Can Cost Hospitals Big Bucks

Cheryl Clark, for HealthLeaders Media, January 20, 2011

The idea that patient experience might be weighted by a regional "grumpiness factor" reminds me of the comical Mrs. Hufnagel, the obnoxious patient in the 1980s TV hospital drama, St. Elsewhere.

No matter how hard hospital teams tried to please her, she always complained, in her grating, gravelly voice. For those who didn't watch the show, Wikipedia provides this appropriate description: "She insulted nearly everyone who tried to help her and was disliked by nearly the entire St. Eligius (Hospital) staff."

Now, as it turns out, hospitals in certain regions of the country are suggesting, in effect, that a disproportionate number of Mrs. Hufnagels seek hospital care in certain parts of the country, specifically New York, New Jersey, and Pennsylvania.

That's the one region, out of nine in the U.S., where a Press Ganey survey last year shows hospital patients are least likely to recommend that facility to friends and family.

Is the care provided in those hospitals really worse? Or is it possible that – generally speaking of course – the culture in those states favors the curmudgeon? They've got an attitude, and even if providers' give perfect care, all you get is a grumble? Maybe grumpiness is, to a greater degree, expected? 

On the other end of the response spectrum, more easily pleased and willing to recommend their hospitals are those patients in New England states and those in the Great Plains: Iowa, Kansas, Minnesota, Montana, Nebraska, and North and South Dakota.

As Blair Childs of Premier Health Alliance suggested in my interview with him last week, "It might be less a function of what the hospital does than the attitude of the population. For example, In New York City, they are grumpier than they are in Minneapolis."

According to the proposed value-based purchasing algorithm, released by the Centers for Medicare and Medicaid Services earlier this month, if there is indeed a grumpiness differential that goes uncorrected, it's going to unfairly cost hospitals money. If the 126-page proposed regulations are approved, the nine-month scoring period will begin July 1. And now, more than before, hospitals are starting to take these survey questions more seriously.

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2 comments on "How Grumpy Patients Can Cost Hospitals Big Bucks"


Jean Budding (2/4/2011 at 2:07 PM)
I agree with Nate Kaufman. Iowa hospitals have been paid unfairly. -Tweener hospitals are reimbursed lower than most hospitals in the nation. The big states didn't care when our reimbursement was 65% of cost. We have great patient scores. And, based on personal experience in Arizona, we have excellent care.

Richard Buchler (1/25/2011 at 5:12 PM)
We have to be careful that we don't make decisions based on opinions versus facts. The only fact in this story is that hospitals in these regions receive lower scores on patient satisfaction. There may be a large population of inherently unhappy people in these regions, but nothing in the original Press Ganey report nor this article supports that conclusion. It is just as likely that those hospitals provide care that is less satisfying to patients than hospitals in the rest of the country.