The ridiculousness of basing reimbursement on customer satisfaction

ventmommy · Jan 24, 2012

I know this isn't the same because we did not have Medicare so I have no idea if what they tie to but I get surveys for every hospital stay and every specialist we see. And every six weeks I get one from OT/PT for each therapist that my kids see. Sometimes, I get 4 or 5 surveys in a week depending on how I had grouped appointments. And sometimes they are for completely random providers. Like "You recently saw NP (or RN or MD) so-and-so in the ER on ___. Please fill out this survery." And they are NOT anonymous because I sometimes get letters that say "On ___ we sent you a customer satisfaction survey and it has not been received..."

And, when did my kids go from being patients to being customers? Actually, now that I wrote that, maybe that is the issue. The mindset of "the customer is always right" can not and should not apply to healthcare. At a restaurant, I can demand extra chocolatey chocolate milk. I shouldn't be able to demand that of my child's nurse or CNA.

Altra, BSN, RN · Jan 24, 2012

I know this isn't the same because we did not have Medicare so I have no idea if what they tie to but I get surveys for every hospital stay and every specialist we see. And every six weeks I get one from OT/PT for each therapist that my kids see. Sometimes, I get 4 or 5 surveys in a week depending on how I had grouped appointments. And sometimes they are for completely random providers. Like "You recently saw NP (or RN or MD) so-and-so in the ER on ___. Please fill out this survery." And they are NOT anonymous because I sometimes get letters that say "On ___ we sent you a customer satisfaction survey and it has not been received..."
And, when did my kids go from being patients to being customers? Actually, now that I wrote that, maybe that is the issue. The mindset of "the customer is always right" can not and should not apply to healthcare. At a restaurant, I can demand extra chocolatey chocolate milk. I shouldn't be able to demand that of my child's nurse or CNA.

The OP discusses the new (effective Oct. or Nov. 2011) Medicare reimbursement formula which does tie a portion of reimbursement to the results of HCAHPS surveys distributed to Medicare patients.

However, customer satisfaction surveys are certainly not new, and are one valid approach to quality improvement.

There are also provider organizations (hospitals, physician groups, etc.) and other insurance payors as well which do utilize survey results as part of their compensation formulas for physicians and other employees.

KelRN215, BSN, RN · Jan 24, 2012

This is my problem with these surveys... they don't actually measure the quality of the care the patients received, but the patients' skewed perceptions of it.

There's a question on the survey my institution uses that asks if anything "made you angry" and, if so, what?

Typical responses:

"The nurses woke my child up in the middle of the night." (Also known as monitoring neuro status)

"The nurses wouldn't give my [able-bodied] teenager [on no activity restrictions] a bed pan and made her walk to the bathroom."

"The nurses wouldn't let my child sleep until noon and woke her up for physical therapy."

"The nurses wouldn't let my child get out of bed and made him use a bed pan." [child is on stroke precautions/strict bedrest]

"My child had to get an IV."

So basically we get complaints about GOOD nursing care.

anotherone, BSN, RN · Jan 24, 2012

The issue is that the patients are usually not able to accurately judge the care they received as evidenced by the constant remarks about poor nursing care for cold food trays or bad food when NURSING HAS NOTHING to do with making the food or handing it out. The other issue is "pain" so many patients excpect to be completely pain free when that is often not possible.

Joe B1 · Jan 24, 2012

The fact that Payment of funds for services provided is being based on something so entirely subjective is obviously a political decision, not one based on any logical reason. I think it should be tied to real, measurable results. Probably never happen.

PintheD · Jan 25, 2012

It's all a bunch of nonsense. What is the worst case scenario for the staff RN if patient satisfaction scores aren't top notch? We will be denied a raise, likely 2%. That's much less than $1000.00 annual after tax dollars. Not the end of the world and not worth the added stress in my book.

Here's some perspective: If patient satisfaction results in a 2% raise than I say make patient satisfaction nonsense 2% of my time and effort on the job. That's 14.4 minutes in a 12 hour shift. Very doable.

These scores are just another manipulation tactic, manipulation of staff and the customer's (read patient) perception of care. Who says manipulation has to be one sided? I say learn all the proper buzz words and repeat them in front of those that care. Then go about your work prioritizing in the way you feel is appropriate for quality nursing care. And keep your hidden agenda hidden!

I'm not saying that patients shouldn't feel they had a satisfactory hospital experience. I just feel it's ridiculous for nursing to shoulder the responsibility. If there are issues with food service fix them! If hospitals want to extend the "hotel experience" to patients hire a concierge for each unit, all shifts! For minimum wage NM's could have an extra body on the floor and free up valuable nursing and nursing assistant time to do nursing. It's a relatively small investment that will pay huge dividends in

increased customer satisfaction and employee morale.

OK, I know this will never happen. In the meantime let's keep things in perspective. Administration is counting on us to make them look good. I, personally, don't care to add a huge bonus to their already huge paychecks. Well, maybe I care a little, just enough to keep my job. That equates to 14.4 minutes every 12 hour shift, the perception of a "can-do" attitude and smiles, smiles, smiles!

gaylarn4 · Jan 25, 2012

It's all a bunch of nonsense. What is the worst case scenario for the staff RN if patient satisfaction scores aren't top notch? We will be denied a raise, likely 2%. That's much less than $1000.00 annual after tax dollars. Not the end of the world and not worth the added stress in my book.
Here's some perspective: If patient satisfaction results in a 2% raise than I say make patient satisfaction nonsense 2% of my time and effort on the job. That's 14.4 minutes in a 12 hour shift. Very doable.
These scores are just another manipulation tactic, manipulation of staff and the customer's (read patient) perception of care. Who says manipulation has to be one sided? I say learn all the proper buzz words and repeat them in front of those that care. Then go about your work prioritizing in the way you feel is appropriate for quality nursing care. And keep your hidden agenda hidden!
I'm not saying that patients shouldn't feel they had a satisfactory hospital experience. I just feel it's ridiculous for nursing to shoulder the responsibility. If there are issues with food service fix them! If hospitals want to extend the "hotel experience" to patients hire a concierge for each unit, all shifts! For minimum wage NM's could have an extra body on the floor and free up valuable nursing and nursing assistant time to do nursing. It's a relatively small investment that will pay huge dividends in
increased customer satisfaction and employee morale.
OK, I know this will never happen. In the meantime let's keep things in perspective. Administration is counting on us to make them look good. I, personally, don't care to add a huge bonus to their already huge paychecks. Well, maybe I care a little, just enough to keep my job. That equates to 14.4 minutes every 12 hour shift, the perception of a "can-do" attitude and smiles, smiles, smiles!

Absolutely agree!!!!!!!!!! I think this is going to backfire on them (hosp admin) in the long run- they are basically taking the attention off of what nurses are supposed to do and making it even harder to do it well- staff cuts, goofy satisfaction surveys!!!!

allnurses Guide · Jan 25, 2012

My son has to offer a survey to every customer checking out of the retail store he works for, but per his manager they must hover over as they do this exhorting the person to "please give us a 5". Real useful info there. :uhoh21: They put a huge value on a good "verbatim" meaning a comment mentioning a name as especially helpful.

So what happens when you inevitably get a person who for reasons unknown to anyone decides to single a person out and blame them for every horrible thing that's happened to them since they were 5 ended up with "thatperson should be fired". It's bunk. Just like saying "I have the time" when your hair has long since gone bad, you look frantic and there's lots of ink stains on your scrubs.

Been there,done that, ASN, RN · Jan 25, 2012

Hey... it's the government... could we expect anything else?

That Guy, BSN, RN, EMT-B · Jan 25, 2012

I honestly think the people that fill those out have zero clue what they are doing. Take for example our latest batch of wonderful surveys.

1. You feel like the nurses respected you - 97%

2. Felt that the nurses listened to your needs - 52%

Um isnt part of respect listening to your needs? Do they even realize what they are answering? I feel like I am dealing with a truck load of derps when it comes to people sometimes.

KelRN215, BSN, RN · Jan 25, 2012

I honestly think the people that fill those out have zero clue what they are doing. Take for example our latest batch of wonderful surveys.
1. You feel like the nurses respected you - 97%
2. Felt that the nurses listened to your needs - 52%
Um isnt part of respect listening to your needs? Do they even realize what they are answering? I feel like I am dealing with a truck load of derps when it comes to people sometimes.

Haha... that's great. Our latest survey wasn't actually on patient satisfaction but patient education. Our PTB decided a few months ago they were going to make education "packets" that every patient with certain new diagnoses needed to get. These packets were, quite obviously, not made by anyone who has done any kind of patient education in the recent past because they consisted of basically an entire foundation's website printed out and put in a folder. The one time I actually gave it to a parent she burst into tears and I couldn't teach her anything because she was so overwhelmed. That was the last time I ever gave that packet to anyone. I prefer to do teaching the way I've always done it- with a few very basic education sheets and more one-one time sitting down discussing the diagnosis.

I read the results of this survey that my manager posted all over our bulletin board in our conference room... to me they looked good. In every question, a maximum of 2 people didn't give the best possible response. Apparently management doesn't understand that, in every group of people you educate, someone is bound to be either a) too overwhelmed/stressed by the new diagnosis to take it all in or b) too stupid. Sorry but it's true. The person who said they weren't taught about their child's medication is probably the person who was taught by 4 separate nurses and given syringes from our supply with the 4 mL mark highlighted so they'd know how much medication to give. I bet these surveys are tied to the patients medical record number, so I'm sure at some point they'll be going through the charts and auditing the documented education and then tracking down nurses that documented that they taught said parents about medication to tell them that, in a survey the parent took several weeks/months later, they said they weren't taught about their medications. Because it's completely impossible to forget things when you're overwhelmed, right?

kcmylorn · Jan 25, 2012

I love the questions on the HCAPS about 1- having their pain controlled adequately- I guess the survey instrument and the hospital administrators don't know about "drug seekers". 2 when you needed help going to the bathroom or the bedpan, did you get the help you wanted "as soon as you wanted it".

I'm in agreement with all the OP posters- make short staff your mode of operations and then send out a survey with questions as dumb as this. That survey and the staffing ratios are an oxymoron- just like the bevy of morons that run our hospitals in this country.!!