Although the Affordable Care Act’s second enrollment period is nearly over, politicians, medical professionals, and the public still debate its implications. According to David Houle and Jonathan Fleece, one-third of all hospitals in the United States will close or be reorganized into another kind of health care provider by 2020. What will differentiate the winners from the losers? Simply put, it will be high patient satisfaction.
In consumer terms what is patient satisfaction? It’s the patient’s view of their overall experience, from the outcome to the institution’s touchpoints with the patient: from the parking valet, to the ER security guard, triage, meals, and billing. Not only is the ACA’s focus on patient satisfaction long overdue, it is just good business practice. As health care consumerism takes hold, providers must adapt. With the growth in high deductible insurance plans, patients have no choice but to become smart consumers, even managers, of their own health care. To understand these implications, one has to look no further than the profound changes that followed employers’ elimination of defined benefit plans in favor of self-directed retirement plans.
What drives the first, second, and third patient visit? While many factors certainly contribute, for the first visit it is the institution’s reputation or brand equity, along with convenience, and accessibility that are preeminent. For second and follow-up visits, patient satisfaction becomes crucial. In fact, nailing the initial visit is critical as additional services are often required for treatment of the patient’s condition.
Provider revenue may be broken down into three buckets: the first visit with a condition, follow-up visits to finalize treatment of the presenting condition, and future visits for new issues. High patient satisfaction enhances the probability that the patient will continue to seek treatment from that provider. Second, and more importantly, it has a profound influence on the institution’s overall reputation as health care consumers research their care options through friends, family, and online. Poor patient satisfaction will damage an institution’s brand equity. When possible, health care consumers will choose another provider. Institutions with low brand equity are more likely to be among the losers, those that close or are taken over.
How do we improve patient satisfaction? From the standpoint of a consumer marketer, let me draw from a recent personal experience. My wife and I noticed that our 10-year-old son Matthew was having significant difficulty breathing, which was highly unusual. Fortunately, living in the NYC metro area, we were within a 5-minute drive of two hospitals and two urgent care facilities. Hoping to avoid a potentially long emergency room wait and limit costly ER expenses, we took him to the closest urgent care center. Instead of being immediately triaged, he waited 30 minutes to be seen. Three attendants hovered around him, scaring him and making him very uncomfortable. Following a chest x-ray and an albuterol treatment, the physician told us to take him to the ER.
Of two local hospitals, we selected the one that had a pediatrics center. He was immediately triaged and seen within an hour by a resident. Due to a shortage of beds, he was admitted the following morning with a respiratory infection. Once acclimated, Matthew tried to manage his care, actively engaging his doctors and nurses. To his confusion, they classified him as having “asthma,” even though he had a respiratory infection and had never previously exhibited asthmatic symptoms. Learning that discharge was contingent upon easy breathing and 4-hour gaps between treatments, our son actively timed each treatment. To our surprise, the hospital staff failed to check his chart during their rounds. They either misstated when his last treatment was or didn’t know. A teacher also visited him at the hospital. She was unaware of his age, grade-level, or school district. To stay current with his classes, she suggested that he go to a website where he could practice standardized math test questions. As she exited his room, Matthew looked at me and cried. Adding to the confusion, to be discharged, he and I had to review an asthma pamphlet.
Reflecting on his care, my wife and I were disappointed. Due to low patient satisfaction, we are not likely to go to either institution again. Why wouldn’t an urgent care facility be pediatric friendly? As a business, why limit your market? Next time we would try the other urgent care facility near our home. The hospital stay was more problematic. His caregivers dismissed him “as a kid,” rather than treating him as an engaged patient monitoring his care. Moreover, their lack of attention to his treatment frequency and confusion around the asthma classification caused unneeded stress to both our son and us. We expected more from a well-regarded children’s center.
As health care slowly transitions to a consumer-driven business, patient satisfaction becomes an increasingly important variable in how patients select their care providers. Over the long-term, it has the power to build or destroy an institution’s brand equity, even impacting its long-term viability. The ACA’s tying of a small percentage of Medicare reimbursement to patient satisfaction has put providers on notice. The revolution begins when health care consumers make purchase decisions in the same manner as they would a new car, TV, or family trip. And in the consumer marketplace, there are winners and losers.
Jim Lahren is a health care consultant.
