A provision of the Patient Protection and Affordable Care Act, enacted in 2010, requires that a portion of hospital reimbursements be decided by patient satisfaction scores. The Hospital Value-Based Purchasing Program, a new pay-for-performance approach, will affect payment for inpatient stays in over 3,500 hospitals across the country. This new legislation and change in reimbursement means that hospitals must assess patient satisfaction and work to improve these scores. Not only is it necessary to determine what satisfies patients, but also how to increase their level of satisfaction. The satisfaction scores are being determined by the nationally standardized Hospital Consumer Assessment of Healthcare Providers (HCAHPS) survey. Past research has shown the impact of various hospital characteristics and their impact on patient satisfaction. This study assesses seven hospital characteristics, including bed size and nurse hours per patient days, and their impacts on HCAHPS patient satisfaction scores. In order to provide an in-depth analysis of patient satisfaction, this study presents information on the background and concept of patient satisfaction, as well as the determinants, causes, and importance of patient satisfaction. It then provides a review of California hospitals and their most common characteristics. Greater nurse hours per patient day are shown to be related to most patient satisfaction scores. However, there isno relationship between nurse hours per patient day and nurse communication scores. More physicians also lead to higher patient satisfaction scores. Lastly, the smallest hospitals have less satisfied patients, and patients in larger hospitals are more likely to recommend the hospital and rate it highly. Advancing research on predictors of patient satisfaction is crucial in order for hospitals to be sustainable in a time of decreased operating budgets and insurance reimbursements. Hospital human resources departments need to be attuned to hiring a more patient-friendly and patient-centric staff. Also, medical schools should update their curriculum to focus more on how to increase patient satisfaction. Future studies on patient satisfaction and hospital characteristics should also include hospital rankings and reviews. This would show whether higher performing hospitals also produce more satisfied patients. Hospitals are a human service organization, and they must now find the best ways to ensure the satisfaction of their patients.