Echoing providers' concerns that HCAPHS might not be the most accurate representation of quality of care, a study published in Risk Management and Insurance Review found that unsatisfied patients frequently received care at otherwise high-scoring hospitals. To determine quality, the authors not only scored hospitals on patient satisfaction and medical outcomes but also included heavily weighted mortality rates. The results underscore the belief of many in the healthcare industry that changes need to be made to patient satisfaction surveys as reimbursements are more closely tied to their results.
More and more hospitals are implementing team-based care approaches in an effort to improve throughput and operational performance. However, while team-based models have been shown to overwhelmingly improve patients' well-being, they might be accelerating physician burnout. A new study has indicated that doctors practicing in a team model showed a 35 percent burnout rate, "compared to 30 percent for doctors practicing a more traditional one-to-one physician-to-clinical-assistant ratio." Researchers were unable to explain the uptick in burnout rates but suggested the need for additional inquiry into what causes physician burnout in the first place.
Although a new rule defining when a hospital patient should receive observation care rather than inpatient care officially took effect October 1, the Centers for Medicare and Medicaid Services (CMS) said they would not enforce the new rule until at least the beginning of 2014. The rule, which requires hospitals "to admit a patient who is expected to stay through at least two midnights," has been criticized by both the hospital industry and patient advocates for being too confusing and placing the burden of cost on patients, who have no say in the matter. The number of patients placed in observation care has increased by 69 percent over the last five years.