How Grumpy Patients Can Cost Hospitals Big Bucks

Cheryl Clark, 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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