The Hospital Value‐Based Purchasing Program: Do hospitalists improve health care value

Abstract

Introduction As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value‐Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores. Methods We used a cross‐sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random‐effects multivariable panel regression models and zero‐inflated negative binomial regression to examine the association between the hospitalist‐staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics. Results A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (β = 5.40; p < .001), Patient Experience (β = 2.49; p <.05), and Efficiency (incidence‐rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists. Conclusion There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.

Factors influencing patient experience in hospital wards: a systematic review

“…Magnet hospital [53,107,136,158] Teaching hospital [56,80,82,91,94,108,117,130,140,147] [56, 107,130,133,157] Safety-net hospitals [51] [51, 107] Most Wired hospital [107] Foundation hospital [117] Faith-based hospital [107] Catholic a liation hospital [88]…”

“…Table 5 was prestented the factors in comunity level(below). Hospital located in larger population area was the most occurring factor, with a positive effect on patient experience in two studies[67, 80] and a negative effect in 7 studies [44,56,74,80,91,94,133]. Three factors such as the education level of community [86] were positively in uencing factors.…”

“…Baldrige hospital [107] Sole Provider hospital [107] Free-standing facility [44] Large dialysis organization facilities [44] System a liation [108,133] Website overall rating [47, Nurse managers' leadership [30,155] Residency learning climate [131] Staff perceived patient safety culture [69, 99,132] Nurse working environment [45] Greater hospital cultural competency [151] * The results of univariate analysis show differences, but speci c causal relationships are not clear…”

Hospital Patient Experience: Exploring Hospitals as Shifters and Sustainers Over Time

“…8,9,10,11,12,13 Higher nursing staffing levels and appropriate hospitalist staffing levels are also significant factors in sustained high-rated patient experience. 12,13 However, a higher percentage of Medicare and Medicaid patients in hospitals have a significant decrease in patient experience. 11,12,13,14 Previous studies have primarily assigned hospitals into two categories, superior and inferior, based on the hospital's overall HCAHPS rating.…”

“…12,13 However, a higher percentage of Medicare and Medicaid patients in hospitals have a significant decrease in patient experience. 11,12,13,14 Previous studies have primarily assigned hospitals into two categories, superior and inferior, based on the hospital's overall HCAHPS rating. Hospitals belonging to the superior cohort were defined in these studies as being either in the top quartile or in the bottom quartile.…”