The Best and Worst States for Medicare Patient Satisfaction Scores

Tying patient satisfaction to reimbursement of hospitals and physicians continues to be one of the more complicated parts of the Affordable Care Act. Ever since the bill was signed in 2010, the Centers for Medicare and Medicaid Services (CMS) has been issuing final rules and guidelines explaining just how much a disgruntled patient may affect reimbursement. In 2012, there were nearly 50 million Medicare enrollees in the United States, and that number will continue to grow as the Baby Boomers march towards retirement.

So while CMS continues to measure how much hospital cleanliness and physician interaction play into patient satisfaction, the Robert Wood Johnson Foundation (RWJF) in Princeton, NJ, looked at patient satisfaction a bit differently. They asked patients if they thought they had received the best care possible in the previous 12 months, and broke it down between those enrolled in managed care Medicare programs and those in fee-for-service programs.

The following are the states (including the District of Columbia) that had the most — and fewest – Medicare beneficiaries rate their care as “best” in the previous 12 months. The rankings are broken up by type, with rankings by fee-for-service beneficiaries coming first, followed by rankings by managed care beneficiaries.

This study data comes from 2009, so we also are including the state’s overall hospital approval scores most recently released by CMS, the October 2012-September 2013 HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores.

FEE-FOR-SERVICE

THE WORST: States with the Fewest Medicare Fee-for-Service Beneficiaries Rating Their Care “Best”

Enrollees Reporting “Best” Care — 50.4%

2012-2013 Overall HCAHPS Score — 66

With the second-highest percentage of senior citizen residents in the nation, Medicare was a big political talking point during this year’s West Virginia congressional election. But locals aren’t thrilled with their FFS care. Apparently, the state isn’t either, after finding nearly $4.7 million in fraudulent billing to local Medicaid and nationwide Medicare by a laboratory testing service.

Enrollees Reporting “Best” Care — 50.3%

2012-2013 Overall HCAHPS Score — 65

New Mexico’s economy is in rough shape, and the healthcare system is no different. With half of all New Mexico residents on Medicare or Medicaid, a state with many different issues to resolve now is dealing with an influx of government-insured patients.

Enrollees Reporting “Best” Care — 49.7%

2012-2013 Overall HCAHPS Score - 70

The only state to see less than half of its FFS beneficiaries call their care the “best,” Arizona didn’t fare too well with managed care beneficiaries, either, raking 38^th with only 51.6% responding favorably. Arizona’s latest HCAHPS overall score is also below the national average of 71. Not great news for the nearly 1 million Medicare enrollees in Arizona … or their doctors.

THE BEST: States with the Most Medicare Fee-for-Service Beneficiaries Rating Their Care “Best”

Enrollees Reporting “Best” Care — 63.5%

2012-2013 Overall HCAHPS Score — 76

Kansas is in the middle of some interesting healthcare policy debates, because newly elected politicians are in support of a multi-state healthcare compact that exempts the state from the Affordable Care Act. In the meantime, though, the Medicare beneficiaries in the plains state are happy with the care they are currently receiving.

Enrollees Reporting “Best” Care — 64.6%

2012-2013 Overall HCAHPS Score — 68

Connecticut seniors have strong Medicare advocates in Washington DC, as 2 Connecticut legislators introduced the Medicare Advantage Participant Bill of Rights Act in both houses of Congress this past summer. The act, though, was in response to a Medicare Advantage program quickly dropping in-network doctors, so it’s possible the state may not maintain its high approval rate in the near future.

Enrollees Reporting “Best” Care — 65.4%

2012-2013 Overall HCAHPS Score — 75

Maybe it’s because, as of 2010, half of all Iowa Medicare beneficiaries have a type of Medigap additional insurance, but senior citizens rate their care very highly in Iowa. The government has taken notice, and Medicare has awarded 2 Iowa hospitals $5.6 million this fall for work in Accountable Care Organizations.

Continue reading for the rankings by Managed Care Beneficiaries…

MANGED CARE

THE BEST: States with the Fewest Medicare Managed Care Beneficiaries Rating Their Care “Best”

NOTE: No data for Managed Care beneficiaries was available for AK, DE, MT, NH, ND, SD, VT and WY.

Enrollees Reporting “Best” Care — 48.4%

2012-2013 Overall HCAHPS Score — 66

Nevada’s seniors are not thrilled with their care. In addition to the third-worst rating for managed care, the state ranked 42nd out of 51 in its FFS Medicare beneficiary scores. But the state is starting to get things turned around in some cases — recently a hospital chain that operates in the state was required to settle for $37 million in Medicare overbilling, and doctors that prescribe a high percentage of potentially addictive pain killers to their elderly patients are being outed publicly.

Enrollees Reporting “Best” Care — 47.8%

2012-2013 Overall HCAHPS Score — 70

The voters of Arkansas spoke in November, saying they want Medicare reform, Republican-style. Looking at the state’s Medicare beneficiaries’ opinion of the care they have been receiving, that may have influenced the vote. In addition to scoring low in managed care, Arkansas’ senior citizens only gave their fee-for-service care a 57.9% positive rating.

Enrollees Reporting “Best” Care — 47%

2012-2013 Overall HCAHPS Score- 72

Interestingly, South Carolina fared well in the fee-for-service care ratings, with 59.1% of beneficiaries declaring their care “best”. That’s 17^th in the nation. But the Palmetto State has some interesting healthcare-related challenges coming up beyond just patient satisfaction — the cost of diabetes hospital care in the state has risen 33% in the last 5 years, with Medicare and Medicaid picking up most of the tab.

THE BEST: States with the Most Medicare Managed Care Beneficiaries Rating Their Care “Best”

Enrollees Reporting “Best” Care — 65.4%

2012-2013 Overall HCAHPS Score — 74

Seniors in the Land of 10,000 Lakes approve their managed care much more readily than their FFS care, ranking second and 37^th nationwide, respectively. But Minnesota is home to the Mayo Clinic, named US News and World Report’s top hospital in the nation this year. Mayo reports HCAHPS scores in the mid-to-high 80’s compared to state-wide 74 and national average of 71.

Enrollees Reporting “Best” Care — 66.5%

2012-2013 Overall HCAHPS Score — 74

Wisconsinites are generally very happy with their Medicare services; the state ranked 15^th in the FFS model as well (59.4%). Wisconsin is also home to a city where more than 90% of residents have signed advance directives — perhaps a sign that regular communication with healthcare providers is more of a norm than an exception.

Enrollees Reporting “Best” Care — 68.8%

2012-2013 Overall HCAHPS Score — 74

Despite having fewer than 300,000 Medicare enrollees, Maine has the third-highest percentage of population age 65 or older, behind only Florida and West Virginia. The state’s seniors enrolled in FFS Medicare also rated their care highly, with nearly 62% giving the “best” rating, good for seventh in the nation. The only question is — do Maine physicians prescribe lobster?

To read the full results of RWJF’s survey, click here.