Data Trends

With the development of the CMS value-based purchasing program and an increasing number of private insurance programs, quality measures and patient satisfaction have become key financial issues. The increased focus on quality commands the attention of hospital and health system senior finance executives as they seek to allocate limited funds with increasing needs. Results of a study of quality differences between replacement facilities and older facilities suggest that new facilities tend to show higher levels of both patient satisfaction and overall quality.

Rural hospitals have historically underinvested in facilities and equipment, and as a result, may suffer from perceptions of low quality of care.a  

The study, with its peer group of 114 replacement critical access hospital (CAH) facilities, provided an opportunity to measure the impact of investment in new facilities on patient perceptions of quality. A review of this peer group's average patient satisfaction scores on the HCAHPS survey compared with the HCAHPS scores of other rural hospitals disclosed that the average scores for the replacement CAHs were significantly higher for every measure of the survey. A new facility could be expected to show a higher score for measures such as cleanliness and quietness (the average median score for the replacement CAHs was 74, compared with 64 for the comparison group). But the new facilities also showed a substantially higher average score in the overall rating (with a median score of 77 among the replacement CAHs, compared with 67 for the comparison group).

The scores of both groups also were evaluated relative to the performance thresholds identified in the Medicare Value-Based Purchasing Program. Overall, the performance of the comparison group was near or below the minimum-defined threshold. The replacement facilities, however, were well within the performance ranges for all measures and were at or near the top for nurse and physician communication and staff responsiveness. Further study is needed to identify the reasons for the differences. Interviews with some CEOs from the replacement facilities indicated a variety of potential factors, including facility design, improved culture, physician engagement in the facility design, and higher staff morale.



This analysis was developed by Stroudwater Associates, Portland, Maine. For more information, contact Brian Haapala at


a. For the purposes of the study, rural hospitals evaluated were limited to federally designated CAHs.

Publication Date: Tuesday, May 01, 2012

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