S. F. Markowiak1, S. M. Pannell1, M. J. Adair1, C. Das1, W. Qu1, F. C. Brunicardi1, M. M. Nazzal1 1University Of Toledo,Department Of Surgery, College Of Medicine And Life Sciences,Toledo, OHIO, USA
Introduction:
The 15-year-old Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was created to compare hospitals by measuring and publicly reporting patients’ perspectives of their care. The survey instrument has been found to be valid and reliable for this purpose. Since the passage of the Affordable Care Act, however, the HCAHPS survey has tied hospital reimbursement to patient satisfaction – a purpose for which the survey was not designed. The purpose of this study was to determine whether HCAHPS scores were influenced by social determinants of health (SDOH).
Methods:
Data were gathered from Centers for Medicare and Medicaid Services (CMS) and US Census Bureau archives. We created a database pairing individual hospital HCAHPS data to corresponding census measures at the county level. FY2013 was excluded because its HCAHPS performance period did not match with a single census period. Multivariate analysis and Pearson’s Correlation Coefficient (Pearson r) were used to test 54 SDOH against HCAHPS score.
Results:
1,150 hospitals in 136 counties were analyzed. Of the 54 SDOH analyzed, 27 had a statistically significant negative correlation with HCAHPS score. 19 had a statistically significant positive correlation with HCAHPS score. Hospitals in communities with higher proportions of government insured patients had statistically lower HCAHPS scores (Pearson r -0.158, p < 0.001) compared to communities with higher rates of private coverage. Hospitals in communities with larger percentages of unemployment had statistically lower HCAHPS scores compared to those with a stronger workforce (Pearson r -0.153, p < 0.001). Hospitals in communities with predominantly Caucasian ethnicity had statistically higher HCAHPS scores than those in ethnically diverse ones (Pearson r 0.153, p < 0.001). For economic SDOH, hospitals located in communities where rent costs exceed 30% of income had lower scores (Pearson r -0.207, p < 0.001). Hospitals located in communities with higher rates of poverty had statistically lower scores (Pearson r -0.045, p 0.003). Hospitals in communities with higher rates of homeownership had higher HCAHPS scores (Pearson r 0.091, p < 0.001).
Conclusion:
Of all SDOH analyzed, 85% had a statistically significant correlation with HCAHPS scores. 59% of SDOH were negative correlations, indicating lower HCAHPS scores for hospitals located in communities with higher rates of poverty, less educational achievement, and more ethnic diversity. 41% of SDOH were positive correlations, indicating that hospitals in wealthier communities with high rates of homeownership, private insurance, and Caucasian ethnicity had better HCAHPS scores. HCAHPS scores are directly tied to a hospital’s CMS reimbursement by federal law. Because of disparities in SDOH, the HCAHPS survey will shift CMS reimbursement from hospitals in poor and diverse communities to hospitals in wealthier ones.