Patients can be more satisfied with hospitals that provide conservative care

This new addition to our Ratings integrates survey responses from more than 1 million patients on their overall satisfaction with thousands of hospitals. The surveys, collected by the federal Centers for Medicare and Medicaid Services, asked patients about their experiences with key aspects of hospital care, such as pain control, discharge planning, and communication with doctors and nurses. Higher patient satisfaction can mean better quality of care, and we think the Ratings will help you find a good hospital.

While building our updated hospital Ratings, based on the Dartmouth Atlas of Healthcare, we noticed something interesting when we examined patient-satisfaction data along with a hospital's approach to chronic care.

You might assume that hospitals that practice more aggressive care—whose chronically ill patients are in the hospital more often and are seen by more doctors—would have more satisfied patients. But as the charts below make clear, there's no connection at all. In fact, for many hospitals the opposite is true: The ones that rank above the national average in patient satisfaction provide, on average, a more conservative (and less expensive) type of medical care.

Consider these 48 hospitals, culled from the 3,415 in our full Ratings database. They're all teaching hospitals, meaning that they provide advanced training to medical residents and interns. Unlike Garrison Keillor's mythical Lake Wobegon, where "all the children are above average," our two lists go in different directions. The first lists 28 teaching hospitals that patients rated significantly above the national average; the second lists 20 teaching hospitals rated significantly below the national average.

While hospitals that deliver aggressive and conservative care appear on both lists, on average the hospitals with higher patient Ratings take a more conservative approach to chronic care. Teaching hospitals with above-average patient Ratings practice a type of care that is more conservative than 59 percent of hospitals, on average, meaning shorter hospital stays and fewer physician visits. Hospitals in the below-average group, in contrast, averaged only in the 16th percentile, meaning that patients in these hospitals receive more aggressive care (seeing more doctors and spending more days in the hospital), thus exposing themselves to more mistakes and more chaotic care.

More conservative care comes with the advantage of lower costs. The next-to-last column in the tables shows the average Medicare spending on chronic-disease patients treated at these hospitals in the last two years of their lives. Medicare spent an average of $31,313 more on chronic patients in the hospitals with below-average patient Ratings than on patients in hospitals with above-average patient scores.

Highest Ranking Teaching Hospitals for Patient Satisfaction (In alphabetical order)

Lowest Ranking Teaching Hospitals for Patient Satisfaction (In alphabetical order)

Guide to the Ratings

For the patient Ratings, the average overall score for all 3,415 hospitals was 65. We identified hospitals with overall scores of 76 or greater as significantly above the national average, and hospitals with overall scores of 53 or lower as significantly below the national average. The hospitals listed here are all members of the Council of Teaching Hospitals. For each hospital listed, we show the patient Rating overall score, the mean Medicare spending in the last two years of life for chronically ill patients, and the percentile score from our Approach to Chronic Care rankings. Because Medicare spending and chronic-care rankings differ by hospital size, we standardized the means of these measures to minimize the effect of differences due to hospital size (determined by the number of beds).