The ridiculousness of basing reimbursement on customer satisfaction

Piglet08 · Jan 24, 2012

"Reimbursement" as in, money to hospitals, or as in, what you personally earn?

If you walk into your annual review with a buncha bad feedback from patients, it will affect your raise. That's just how it is.

And it's a damn shame that patients often can't tell when they're getting excellent nursing care, because that might require the patient to take some responsibility, experience some discomfort, actively participate, cough and deep breathe even though it hurts.

wooh, BSN, RN · Jan 24, 2012

It doesn't even need to be bad feedback from MY patients. If my floor doesn't get a high enough score, that kills a whole segment of all of our raises on the floor. Even if I'm the sugary sweet nurse that lets the patients do whatever they want and that they all love.

jennilynn · Jan 24, 2012

Not to mention, there are some people that you just cannot please. Around here, our patient satisfaction surveys range from the care they received to if their meals were acceptable. So, my care that I give can be cut down because they got vanilla pudding instead of chocolate pudding or because their family didn't get a meal tray (which we don't provide to family members anymore) and had to pay for a meal in the cafeteria. I understand customer service and all that, but this is a littl,e over the top, IMO.

PMFB-RN, RN · Jan 24, 2012

Raises? You guys can get raises based on your, or your units preformance? Wow, I thought such things where a thing of the past.

imintrouble, BSN, RN · Jan 24, 2012

Cutting staff to save money and improving customer satisfaction simply don't go together. We've had the no raise/no happy customer talk on our floor. All while we barely have enough staff to wipe butts, much less make hot chocolate and fluff pillows.

Altra, BSN, RN · Jan 24, 2012

At Kroger's ... you pay upfront, or you make the choice to go down the street to the next grocery store. Kroger's doesn't have to wait for "reimbursement" dependent on whether or not you burn the meal that you attempted to cook with the groceries you bought.

Remember, the reimbursement tied to patient surveys is from Medicare, not all payor sources. Although private insurers typically follow the standards set by CMS for Medicare, which derive from quasi-governmental agency JCAHO.

But, ya know, we like to pretend we have free market health care in this country ...

HouTx, BSN, MSN, EdD · Jan 24, 2012

The OP is referring to HCAHPS (HCAHPS - Facts Page) which is going to determine payment rates to hospitals.

I agree with the principle of not paying the same amount for crappy service that you pay for great service, but there should be a way to determine how much of the 'rating' is due to unrealistic expectations. For instance, a lot of patients think they will have no post-op pain... sometimes because that's what the doctor told them when she was convincing them to have the surgery. It's also a fact that the survey is completed by family members rather than the patient... and they don't even know what was going on outside of their visiting time.

Unfortunately, it seems that one of the most effective ways to deal with HCAHPS is by trying to influence patient recall though repetitive and consistent information that (we hope) they will remember when it comes time to fill out the survey. That is why everyone is scripting... "our goal is to manage your pain effectively" or some such thing on an hourly basis. Hmm - maybe we can insert speakers into the mattress & play subliminal messages whenever they are asleep? Just a thought.

imintrouble, BSN, RN · Jan 24, 2012

If hospital reimbursement is going to be tied to customer satisfaction surveys, I think EVERYTHING should be tied to customer satisfaction surveys. There was some ridiculousness at the Kroger grocery store tonight. I'd only give them a 4 out of 5. Thus, my groceries should be free. Oh, and I'm unhappy with one of my grades. So my tuition should be free. There's also been a number of times that lately that I turn the tv on, and there's not an episode of Law & Order on any of the stations. That makes me unhappy, thus nobody at DirecTV should get a raise and I should get my service for free. And the groceries I used from the previous visit gave me a bit of heartburn. Thus THOSE groceries should also be free. And my cat just gave me a funny look. Now I know my internet service has nothing to do with that, but I'm going to complain to them anyway, and thus my internet should be free.

It's the Walmart business model for hospitals. You buy a product, don't like it, then you don't have to pay for it. Ever see a Walmart customer return a half eaten birthday cake? Every expectation is worth consideration. Every customer request has merit. Anything to make the customer happy. If the customer is not happy you give them a ten dollar gift card to ease their pain.

OwlieO.O · Jan 24, 2012

The only problem with that is there are very disgruntled patients who, despite you and other staff members doing their job extraordinarily well, will give poor surveys. They just want to watch the world burn. Often people don't understand that certain aspects of their care that they didn't like was best for them, and they go home ****** off. I heard once of a guy who had some fingers chopped off (carpenter), and as he was unconscious, and no family there, the surgeon decided to reattach them in his best interest. He was furious because his insurance couldn't cover it. But hey, he can still work!

Perpetual Student · Jan 24, 2012

Something that really irks me about most of these surveys is that only the max score counts. Frankly, with most of those factors doing a consistently good job is sufficient. The highest scores in life used to be reserved for perfection. I know that until I became familiar with how this crap works that I almost never gave anyone max scores for anything. I've always been a fan of the 2nd highest score for most things, as there is always room for improvement.

Also, anything above the 50th percentile should be considered pretty darned good--I mean that's better than half the competition. And the average hospital in the US isn't all that bad. Sure, the worst 20% or so are pretty scary, but even there it's a lot better than the third world. Frankly, looking at some of the things people complain about makes it hard to take this stuff seriously.

OCNRN63, RN · Jan 24, 2012

If hospital reimbursement is going to be tied to customer satisfaction surveys, I think EVERYTHING should be tied to customer satisfaction surveys. There was some ridiculousness at the Kroger grocery store tonight. I'd only give them a 4 out of 5. Thus, my groceries should be free. Oh, and I'm unhappy with one of my grades. So my tuition should be free. There's also been a number of times that lately that I turn the tv on, and there's not an episode of Law & Order on any of the stations. That makes me unhappy, thus nobody at DirecTV should get a raise and I should get my service for free. And the groceries I used from the previous visit gave me a bit of heartburn. Thus THOSE groceries should also be free. And my cat just gave me a funny look. Now I know my internet service has nothing to do with that, but I'm going to complain to them anyway, and thus my internet should be free.

OMG, you are my kind of gal. A fan of L&O and a cat lover!

And yes, I agree with you. I had someone complain to me that we didn't have tuna fish sandwiches, and why couldn't I get one for her. If she gets a survey, dollars to donuts she'll complain that the "mean nurse didn't get her a tuna fish sandwich."