Date of Award

2013

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Andrea W. White

Third Advisor

William O. Cleverley

Abstract

Hospitals are the ultimate service providers in that no goods are produced. Hospital employees and independent providers deliver a highly technical set of services with the noble goal of improving the state of wellness of their patients. Historically, the hospital industry considered satisfying patients as secondary to conquering the disease of the patient. CMS' implementation of a Pay-For-Performance (P4P) system, within the context of a Value Based Purchasing (VBP) program, altered providers' perspective by associating a financial reward/penalty based on how well hospitals satisfied patients, as well as based on the provision of core clinical processes. In future years, the P4P process will be modified to include clinical outcomes and an overall community cost measure. Using Medicare cost report financial data as assembled by Cleverley and Associates, system definition from Major Accounts Exchange that provides services to the purchasing industry, CMS' HCAHPS survey, and Council on Teaching Hospitals (COTH) data for teaching status, this research explored the association between patient experience and inpatient costs for most US Short Term General Non Federal (STGNF) hospitals. Data from approximately 3,500 hospitals in each year from 2009 through 2011 is analyzed, with a total of 10,683 data points. During the period 2009 through 2011, based on ANOVA, correlation and OLS regression analysis performed on hospital costs and hospital characteristics, a statistically significant relationship is found between inpatient costs and percent of patients rating a hospital as a 9 or 10. Including other independent variables, the regression model explains about 23% of the variation in rating scores. The results provide empirical evidence that the P4P model implemented by CMS coincides with a change in focus for hospitals to include improving patient satisfaction. Accounting for other hospital characteristics, patient satisfaction is associated with higher cost of care during the period that coincides with the implementation of CMS' P4P initiative. Decreases in the value of the coefficient for costs over the three year period may indicate that hospitals are becoming more efficient in delivering higher levels of patient experience.

Rights

All rights reserved. Copyright is held by the author.

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