Patients who choose higher performing hospitals spurred nationwide gains in survival rates for heart attack, congestive heart failure and pneumonia, according to a study from healthcare economists published by the National Bureau of Economic Research.
Medicare patients who went to hospitals with better outcomes between 1996 and 2008 help explain 20 percent of a 4.8 percentage point increase in 30-day survival rates for heart attacks over that time period, according to the study. The other 80 percent is attributable to in-hospital quality improvements and technology upgrades.
Patients choosing better hospitals contributed to gains in congestive heart failure and pneumonia survival rates as well.
Researchers found better CMS-reported outcomes are correlated with higher patient volumes and market share for hospitals. "We find robust evidence that higher quality hospitals — as measured by risk-adjusted survival, risk-adjusted readmissions and adherence to well-established clinical practice guidelines — tend to attract greater market share at a point in time and to grow more over time," the study reads.
Hospitals with heart attack survival rates that are one percentage point higher than the average have 17 percent higher market share at one point in time and a 1.5 percentage point higher growth in market share over two years, according to the study.
Patients are also willing to travel further for better care — on average, patients are willing to go an additional 1.8 miles for a hospital with better outcomes. Even when a heart attack patient is admitted through the emergency department, only half are treated at the hospital nearest to where they experienced a heart attack.
"This fact helps illustrate that a demand-based mechanism can still exist for these patients, even if their ability to choose a hospital is more constrained: Some decision-maker, whether that is the patient, his family, his doctor or the ambulance driver, is still exercising active choice for a large share of ED admissions," according to the study.
Unlike outcome measurements, patient satisfaction scores do not seem to drive patients to hospitals. "Hospitals that score better on ex-post measures of patients' satisfaction with their experience…do not attract greater market share," the study reads.
However, some studies have found that hospitals with higher patient satisfaction scores also have lower mortality and readmission rates than lower-scoring hospitals.