Dive Brief:

• As the HHS pushes toward value-based reimbursements and the ACA has Medicare awarding cash to providers who score big in quality and patient satisfaction, smaller hospitals may have a significant advantage over big ones, according to an NPR report.
• The piece compares the "mom and pop" feel of many small hospitals—like Medical Park Hospital in Winston-Salem, North Carolina—to the crowded, more active atmosphere of large city hospitals with packed waiting rooms and higher patient-to-clinical staff ratios. Medical Park earned a $22,000 reward from Medicare last year, in part for its scores on patient satisfaction surveys. Parent company Novant Health did not have any other hospital in its chain receive any similar rewards, according to the article.
• "A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals]," Chas Roades, chief research officer with healthcare consulting firm Advisory Board Company, told NPR. "In particular, the big teaching hospitals, urban trauma centers—those kind of facilities don't tend to do as well in patient satisfaction."

Dive Insight:

Comparing large hospitals to small hospitals is like comparing LaGuardia to an executive airport. Large airports are designed to get as many people as possible in and out as fast—and as cheaply—as humanly possible. The small airports usually only have one runway, and there is never a line of planes waiting to land.

So, on the surface, it would seem that small hospitals do have an advantage over big hospitals in terms of patient satisfaction, but only on the surface. When administrators and clinicians dig deeper, they tend to discover that patient satisfaction is the underlying current that drives every provider, big and small. Just because a patient is in a large facility with a lot of patients does not mean that the patient experience will automatically be bad, or less satisfying than at a small hospital. After all, large hospitals often have population management tools at their disposal that are beyond the grasp of smaller facilities, and can have  big impact on patient care. 

Large hospitals can provide "mom and pop" experiences, as well. Tampa General Hospital's palliative care unit, for example, eschews the traditional hospital room in favor of a more comforting setting that you wouldn't think to find at a big city provider. Other large hospitals are hiring "patient navigators" to help patients through their hospital stays with great success. A lot of it comes down to available funding, not the size of the institution. 

Patient experiences drive those satisfaction surveys (and a certain amount of financial gain), and it may be premature to argue that the size of a hospital automatically prohibits it from satisfying patients every bit as well as its smaller competitor. Steps like putting navigators in place may not close the "small vs. large" gap completely, but it's a start.