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The 20 hospitals with the highest dissatisfaction rates in America

Here are the twenty hospitals in America with the lowest recommendation rates by patients whom they serve, according to data from the official HCAHPS survey, accessed October 2013 from the Medicare data website:
What is "HCAHPS"? HCAHPS is best explained by their own fact sheet:
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care... While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there were no common metrics and no national standards for collecting and publicly reporting information about patient experience of care. Since 2008, HCAHPS has allowed valid comparisons to be made across hospitals locally, regionally and nationally. 
Why is HCAHPS important? The answer is "money". Again, from the fact sheet:
HCAHPS and Hospital Value-Based Purchasing. The FY 2014 Hospital Value-Based Purchasing (Hospital VBP) program links a portion of IPPS hospitals' payment from CMS to performance on a set of quality measures, which include the Clinical Process of Care Domain, which accounts for 45% of a hospital’s Total Performance Score (TPS); the Patient Experience of Care Domain, 30% of TPS; and the new Outcome Domain, 25% of TPS. The HCAHPS Survey is the basis of the Patient Experience of Care Domain. 

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