Tying Patient Satisfaction to Medicare Reimbursement is Problematic - page 5

by TheCommuter 19,469 Views | 62 Comments Senior Moderator

Patient satisfaction surveys have been receiving an amplified amount of attention at hospitals and other types of healthcare facilities, especially since the results of these reviews now have a significant effect on Medicare... Read More


  1. 0
    Excellent Point, hospitals are not hotels and we don't have 24 room service!
  2. 5
    Quote from Kunzieo
    Who comes up with this?

    From President Obama's 2013 State of the Union address:

    "We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital. They should be based on the quality of care that our seniors receive."

    Really, Mr. President? So should my bill at Applebee's not reflect how much food I ordered or how many Mucho Margaritas I consumed but rather how much I enjoyed my meal and if it was served with a smile? ********.


    State of the Union 2013: President Obama?s address to Congress (Transcript) - Page 2 - Washington Post
    Considering this came through the pipelines LONG before January 2013 (and before PPACA for that matter) I don't think we can blame the president for this. And considering he said "quality of care" not quality of service, not sure how that applies anyway...
    toomuchbaloney, Sammie7, BrandonLPN, and 2 others like this.
  3. 2
    Amen to that. What the patient wants is not always what is best. If they had the ability and knowledge to take care of themselves, they wouldn't be in the hospital. Not to say that we should ignore their requests entirely, but sometimes they need to be encouraged to make healthier choices.
    CMonetRN and tewdles like this.
  4. 0
    Who should determine what quality care is? I work in an area of nursing regulated by medicare goals and payment based on patient quality outcomes. Obtaining quality care or outcomes is related to patient choice. Also the patient's economic means impacts their success at obtaining the outcomes. Patient's who are worried about basic needs such as food and shelter, tend not to worry about long term consequences of not following through with prescribed medical treatment. Why should the hospital be penalized for a poorly controlled diabetic with numerous admissions throughout the year due to infected wounds and out of control glucose levels?
  5. 1
    Hospitals should be part of a larger health care system for a community.
    The continuum of care and health within that community is both a shared endeavor and responsibility.
    Poor communities with few resources to assist the disadvantaged will have poorer health outcomes for patients mentioned by Marisette.

    How do we fix these problems??
    BrandonLPN likes this.
  6. 2
    Good question tewdles.

    I think encouraging people to make healthy choices and educating them on the results of poor choices may be the best way to improve the overall health of our society. We need to make people feel empowered to guide their own lives. I like some of the "in your face" kind of advertisements to show people the seriousness of ignoring DM, HTN, or PVD.

    Here's a thought, instead of penalizing health care providers for patients who don't meet metrics why not re-direct the financial incentive to the patients? I used to work for a company that gave us a substantial insurance premium discount for not using tobacco. Incentives could be given for maintaining a health BP, a1c, % bodyfat (I hate BMI).

    Penalizing health care providers just seems counterproductive to me.
    toomuchbaloney and tewdles like this.
  7. 2
    I have often wondered just who came up with these surveys and questions, and would like to know how many times have they followed a nurse on their shift to see for themselves what we all have to do to take and give good care to our patients. How can they be the ones who determine what is or is not good care, and I really need someone to explain to me just how it became the nurse's responsibility to make sure the patient understand their diagnosis and every aspect of it as it relates to their health and outcomes to be achieved? What happened to the doctor's responsibility to the patients to explain all the tests that are ordered and why they are important to knowing how to treat the patient correctly?
    It is always been left up to the nurse to "teach" the patient what they need to know to prevent additional hospital readmissions, what medications they are taking and why, what medicines they are to stop taking, what exercises or activities they need to start or decrease and why. What happened to the other departments in the hospital that should be teaching the patient about oxygen at home, how to use incentive spirometers, and why, what diets they are to follow relating to diagnosis and why it is important to their health; how to use crutches, walkers, do ADLS, etc? It always fall to nurses to do all the education in addition to providing safe and reasonable care during their hospital stay.
    Don't let us forget the importance of "wording scripted" phrases to re-enforce to the patient/family that we are only to happy to be given them "excellent" care and that we have the time to be at their beck & call for anything regardless of whatever else our day might include. Please don"t forget the 5 "P" when you go into that room every 1-2hrs to see if they require anything. and close the door for "Privacy"
    I just wish that someone from the Robert Wood Johnson Foundation would come and follow me around for 12+ hrs and see how easy it is to do all they require done for the patient(regardless of how many patients you have assigned to you) and have to do for each patient under your care for that shift, then have them to do it and let me critique them on how well the accomplished the set tasks for each, and don't forget all the charting and everything else a nurse has to do.
    How long do you think one of them would last? How long do you think your Nurse Manage could make it doing your job? My manage does not know just what all a staff nurse must do, and is constantly on us to improve our scores!
    Sorry about going on so long but this is just something that grips my a## when I am the one that spent all those long hours obtaining my nursing degree and now everytime you get 1 negative comment, whether or not it has merit, you get wrote up because the patient ( or should i say the customer) is always right
    noyesno and sistasoul like this.
  8. 0
    Quote from MECO28
    Astute as always, Commuter. I had a patient just the other day who had one of the most experienced nurses on out unit but wasn't happy with her. Why? Because this nurse does not coddle and is very matter-of-fact. She is the first to notice a change in condition and to meet that change with the appropriate intervention but this patient felt she wasn't empathetic enough.

    It's a sad day when experience and excellent care mean less than remembering no ice in the water and extra snacks. I could go on...
    Exactly. We, as nurses, are often more clinically oriented, especially in critical situations. This means we often do not have time to hold the patient's hand and say, "it'll be OK" (or similar). Too often, the patients put our work secondary to the customer service stuff and will respond with a lousy Press Ganey (Press Whiney?) because of one small and inconsequential thing they choose to nitpick. Some even turn in a bad review because they were not allowed to smoke (or do other harmful things) in the hospital.

    Yes tying surveys and reimbursement based on a government standard is a problem (not an "issue"), and it is only the beginning.
  9. 0
    Ok...I thought that the "outcomes" were being based on nursing interventions...not pt satisfaction scores...is there something I'm missing??

    Examples when I google:

    http://confidenceconnected.com/conne...ng_never_even/

    http://www.nursingcenter.com/lnc/jou...icle_ID=798117

    ^there's a link to the new CMS rule...they want to increase funding in regards to outcomes related to nursing care, and whether the care was satisfactory based on the patient not returning immediately. They have found when nursing interventions were counted, there was an increase of better outcomes...it's the CMS-1533-FC, a 2000+ page report...these rules have been established since 2006, updated in 2008, and now most are hearing about "pt outcomes" because they gave hospitals a grace period, and it's almost over.

    We have a program were I work where we nurses document whether the pt should be upgraded due to pt care load/skilled hours. It helps with outcomes and how many nurses are needed to help with staffing to provide adequate care for positive nursing outcomes.

    I have yet to hear about the reimbursement being tied to pt satisfaction. I have heard otherwise, been told otherwise, gave the examples from where this information can be found and use the program that documents the outcomes. If this is not the case, if anyone has this info please point me to it. Thanks.
  10. 1
    http://www.cms.gov/Medicare/Quality-...talHCAHPS.html

    Ok...I found some information. First, this has been around since the mid 2000s. CAHs-Critical Access Hospitals, hospitals that serve the under served it is optional to report the surveys. If they are a for profit and they FAIL to report it, then it affects funding...it doesn't say that it directly affects it, it ONLY affects it if certain hospitals fail to report their surveys. Those Press-Ganey etc is not made up...these survey questions came from CMS...they were contracted by Medicare.

    It was an experiment, and it has been around for close to 10 years. Even if people are upset about it, it's been around LONG before ACA...and affecting funding before then.

    The places need to cough the surveys up, that's all. If hospitals want us to work harder, etc, if it's a crappy hospital, it's going to get not such a great survey, it's best to come clean... And if CMS wants them to improve, I think they are going to force them to, not the other way around...more nurses, better, food, etc. I don't think of this as a bad thing. It will expose the hospitals for not focusing on the patients but the bottom line.
    TheCommuter likes this.


Top