Orthopedic Surgeons: Insist on Private Rooms for TJA Patients!

By Elizabeth Hofheinz, M.P.H., M.Ed., November 27, 2019 While virtually any patient would prefer a private hospital room as opposed to sharing space with someone else during what is typically a stressful time, little data is available on the relationship between the type of room and patient perceptions of their experiences. With many orthopedic surgeons seeking ways to improve the experience of total joint patients—and given the reality that reimbursement is linked to quality metrics, a team of researchers from the Department of Orthopedic Surgery at NYU Langone Health, NYU Langone Orthopedic Hospital set out to use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey—administered by the CMS—to examine patient perceptions. The survey includes questions regarding, for example, communication with staff, responsiveness of staff, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment. Such data is routinely used to inform hospital quality rankings and hospital reimbursements. The authors wrote, “In the value-based purchasing initiative, hospitals can receive a penalty or bonus of up to 2% of their total reimbursement from Medicare, with HCAHPS performance accounting for 25% of the overall hospital performance score.” Joseph Bosco, III, M.D., Director of Quality and Patient Safety at NYU Langone Orthopedic Hospital, noted, “Our institution underwent an extensive renovation converting all double-bedded rooms to single bedded rooms and we noticed an increase in patient satisfaction. To our knowledge this is the first work to compare HCAHPS between single- and double-bedded rooms.” Data was obtained on patients who underwent primary THA or TKA at NYU Langone Orthopedic Hospital between October 2015 and December 2017. The authors wrote, “Double-occupancy rooms are divided so that the one patient is adjacent to the window and the other patient is adjacent to the bathroom and the hallway door. Patient assignment to private versus double-occupancy rooms is performed at random by the admitting staff, unless the patient is placed on infection pre- cautions requiring a private room.” “We focused our analysis on specific metrics that encompassed global assessment (hospital recommendation and overall hospital rating), surgeon assessment (listening, explanations, and treatment with courtesy and respect), and hospital assessment (call button help, quietness),” stated the authors. Asked how this may lead to increased reimbursement, Dr. Bosco commented to OSN, “Patient satisfaction is tied to quality measures which are tied to reimbursement both at the hospital and physician level. Thus, higher HCAHPS lead to increased reimbursement in value-based care.” “We were surprised to learn that the rooms which were converted from single bedded rooms to double bedded rooms without being renovated were associated with increased HCAHPS scores and patient satisfaction.” The authors stated, “…we found that patients assigned to private rooms had higher global ratings of the hospital, were more likely to recommend the hospital, and reported greater satisfaction with the hospital environment as compared to patients in shared rooms. However, surgeon evaluations did not significantly differ by room type.” Dr. Bosco commented to OSN, "Orthopedic surgeons should insist that their patients be housed in single-bedded rooms after joint replacement surgery. Their HCAHPS scores are being compared to their peers whose patients are in single-bedded rooms.”

Orthopedic Surgeons: Insist on Private Rooms for TJA Patients!

Elizabeth Hofheinz

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