Medicaid reimbursement and patient satisfaction scores

[RN-ing]

I work for a small non-profit hospital and starting in 2012 (I think??) a percentage of our Medicaid/Medicare reimbursement will be based on random patient satisfaction surveys after discharge. Management has taken a defensive stance towards nurses, basically saying we have to "shape up or ship out". Seriously, an actual email from our CEO stating employees are "either with *** hospital or against it".

Not feeling the love at work right now!

Anyone else in this situation willing to share thoughts?

[morte, LPN, LVN]

hmmm I thought we had the right to be "judged by our peers"? patients are certainly not our peers (job wise)

how can they give a rational opinion on care....oh, right, they can't!

[flashpoint]

The bad thing about this is that a lot of people don't base satisfaction on the things that are truly important.

We often get complaints about meals...some of it is justifiable, but how much can we do about a clear liquid diet...or a low sodium, no concentrated sweets, renal, pureed diet? Will we really lose reimbursement because someone didn't like their apple juice and chicken broth?

Will we lose money because someone had to wait for their call light to be answered because we were busy doing silly things like CPR? Will things like a patient being uncomfortable because they had to lie flat after a spinal tap have an effect?

This is just perplexing to me...

[madwife2002, BSN, RN]

Look to the dialysis companies it already started with them 1st January 2011

Everything has changed for us and we are told we will be fined and money taken away for almost anything we do or dont do. Keep you eyes on what happens there and you may have a guide for next year

[jbjelus1]

The patient satisfaction thing is a buch of crap at times if you ask me. It's true as mentioned that most of the time when you get surveys back it's about what the patient didn't like or what wasn't done for them. I even worked for a facility where we got docked on our yearly evaluations for patient satisfaction scores not being where the manager wanted them to be, and that is when I decided that I had had enough and started looking for another job

[KneKno]

When do the nurses get a chance to "fill out a survey" about the patients? Did they smile, did they show interest in learning about their meds, did they volunteer to walk 3 times on post op day 1 or did the nurse have to "encourage" them, did they use the inspirometer without reminders? And, I'd also like to give my opinion about the visitors..... think they will they "Strive for 5?"

[BluegrassRN]

This is what we are hearing at our hospital, as well.

Just some clarification, the survey is a phone survey, not a paper one. While that won't completely eliminate bias from those who are more likely to respond because of bad care, I think it probably helps reduce it significantly.

My understanding is that the scores are comparative. Meaning, you are compared to similarly sized hospitals in similar environments. This is what our manager is telling us.

I don't agree with tying reimbursement to patient satisfaction scores, though I see the value in obtaining those numbers. We've made a lot of positive changes in how we do staffing and report based on this. Our scores for room cleanliness and answering call lights were in the toilet, and our administration finally stopped pulling all our housekeepers to sit and started staffing us *a little* better to improve these scores.

I think these scores are nothing without the additional info of outcomes. If your patient satisfaction scores are great, but 50% of your MI pts die within 30 days of discharge, do you still get your full reimbursement? I understand the desire to tie outcomes with reimbursement, but I think there needs to be some balance. Good outcomes in core measures should count towards something, regardless of your patient satisfaction scores. Satisfaction scores shouldn't count for anything if your outcomes are terrible.

[linearthinker, DNP, RN]

Few of the pts I have seen in 20+ years of nursing have enough understanding of anything (including the english language) to competently evaluate anything more complex than the thread count of the sheets. Should be interesting.

[bigpoppadoppler]

This has absolutely nothing to do with improving care. This is just another nail in the coffin of private enterprise in America. When Universal Health Care kicks in and your hospital falls below "xth" percentile in satisfaction scores, our glorious government saviours will take over one hospital at a time and save us from ourselves.