HCAHPS Scores = hospital pay

[A&OxNone]

Not sure if anybody else's facility has started stressing this (I'm sure mine isn't the only one...) but I wanted to see what nurses thought about this change, basically that the HCAHPS scores will determine how much Medicare will pay the hospital.

" Scoring in the Hospital Value Based Purchasing Program will be based on whether a hospital meets or exceeds the performance standards established with respect to the measures. By adopting this program, we will reward hospitals based on actual quality performance on measures, rather than simply reporting data for those measures."

All the articles I find on this are pretty dense... here's the most basic I can find..

http://www.hhs.gov/news/press/2011pres/04/20110429a.html

How do you think this will effect us?

[That Guy, BSN, RN, EMT-B]

I would be banned from this site if I gave my true comments on HCAHPS.

[jones.rn]

My hospital is obsessed with HCAHPS. Everything they do seems to be focused around it. And believe me, the outcomes are not always good for the nurses. They allow patients to abuse us and the system because they want to be reimbursed. It's craziness.

[RhinoRocketRN]

My hospital is obsessed with HCAHPS. Everything they do seems to be focused around it. And believe me, the outcomes are not always good for the nurses. They allow patients to abuse us and the system because they want to be reimbursed. It's craziness.

Same here:uhoh3:

[MunoRN, RN]

I know it sucks but it could be worse; Imagine if the title of this thread was HCAHPS scores = Nurse Pay.

That's exactly what one of my area Hospitals is proposing with their next contract. On top of proposing a 16% pay cut across the board for Nurses, they are proposing additional pay cuts based on Nursing sensitive indicators on the HCAHPS.

[RhinoRocketRN]

Its just not right considering its patient opinion and some people are never happy

[nursej22, MSN, RN]

Reminds me a a T-shirt slogan: "The floggings will continue until morale improves"

[freemirini]

I actually wonder if linking the scores to reimbursement will cause hospitals to adjust their staffing ratios. In general, I have noticed that hospitals with better scores tend to have better nurse-to-patient ratios. --I imagine that some "flogging" of staff will go on, but if hospitals are losing money they may just adjust their policies.

[A&OxNone, MSN, RN]

I will say that yes, it is just Medicare reimburstment, BUT, in my hospital, as many as 70% of our admitted patients are on Medicare. So this is a lot of money we're talking about.

Also, It drives me crazy about the patient satisfaction survey. They ask things like,"How often did your nurse respond to your call light" and "How often was your pain controlled" which ARE important, YES. But from what I understand, the only choices the pt gets are ,"Always, Usually, Never." or something to that extent. Well, as a patient, I would think "usually" would be a good response, but the only the we will get paid for are the "Always" responses.

At least that's how it's been explained at my facility. Somebody correct me if I'm wrong... I love a dose of education. :)

[JacknSweetpea]

We are all in big trouble. I can just hear management's flexing of "executive muscles"!

[NRSKarenRN, BSN, RN]

government as payer of healthcare services, wants to ensure its members are getting high quality care ...so varying types providers of care required to survey its users. now payment for care based on perceived qulity is whats driving facilites into hyperdrive over issue. ana has spearedheaded efforts to focus on nursing quality indicators as #1 reason patients are admitted to hospitals,snf and home care is due to need for nursing care.

hcahps - hospital survey

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overview

the hcahps (hospital consumer assessment of healthcare providers and systems) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. hcahps (pronounced "h-caps"), also known as the cahps® hospital survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. while many hospitals have collected information on patient satisfaction for their own internal use, until hcahps there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

three broad goals have shaped hcahps. first, the survey is designed to produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers. second, public reporting of the survey results creates new incentives for hospitals to improve quality of care. third, public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment. with these goals in mind, the centers for medicare & medicaid services (cms) and the hcahps project team have taken substantial steps to assure that the survey is credible, useful, and practical. ...

...the recently enacted patient protection and affordable care act of 2010 (p.l. 111-148) includes hcahps among the measures to be used to calculate value-based incentive payments in the hospital value-based purchasing program, beginning with discharges in october 2012....

hcahpscontent and administration

the hcahps survey asks discharged patients 27 questions about their recent hospital stay. the survey contains 18 core questions about critical aspects of patients’ hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital). the survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support congressionally-mandated reports.

the hcahps survey is administered to a random sample of adult patients across medical conditions between 48 hours and six weeks after discharge; the survey is not restricted to medicare beneficiaries ..

...hospitals can use the hcahps survey alone, or include additional questions after the core hcahps items. hospitals must survey patients throughout each month of the year. the survey is available in official english, spanish, chinese, russian and vietnamese versions. the survey and its protocols for sampling, data collection and coding, and file submission can be found in the hcahps quality assurance guidelines, version 5.0, which is available on the official hcahps website, www.hcahpsonline.org.

http://www.hcahpsonline.org/facts.aspx

the cahps home health survey

the cahps home health care survey is a measure of patients’ experiences with home health care providers and agencies. developed by the agency for healthcare research and quality (ahrq), this instrument focuses on patients who receive skilled home health care services from medicare-certified home health agencies (hhas). skilled services refer to health care services provided by nurses and therapists including physical, occupational, and speech-language therapists.

national database of nursing quality indicators

participation in the american nurses association's national database of nursing quality indicators® (ndnqi®) satisfies cms' reporting requirement.

the centers for medicare & medicaid services’ (cms) program for reporting hospital quality data for annual payment update (rhqdapu) now includes a focus on measuring nursing quality. beginning in fiscal year (fy) 2010, the cms requirement will include hospital reporting on whether or not you participate in a systematic clinical database registry for nursing-sensitive care.

there is increasing national focus on nursing quality. some states require public reporting on nursing quality measures and the federal government may do so in the future. with the increasing governmental and payer focus on nursing quality, now is the time for all hospitals to participate in ndnqi. more than 1500 hospitals in the u.s.—1 out of every 4—already do...

what indicators are collected?

information is collected on the following indicators.

• patient falls / injury falls
  
• pressure ulcers:
  
  • hospital acquired
    
  • unit acquired
    

  [*]physical/sexual assault

  [*]pain assessment/intervention/reassessment cycle

  [*]peripheral iv infiltration

  [*]physical restraints

  [*]healthcare-associated infections:

  • catheter-associated uti
    
  • central line-associated blood stream infection
    
  • ventilator-associated pneumonia
    

  [*]staff mix :

  • registered nurses (rns)
    
  • licensed practical/vocational nurses (lpn/lvns)
    
  • unlicensed assistive personnel (uap)
    

  [*]nursing care hours provided per patient day

  [*]nurse turnover:

  • total
    
  • adapted nqf voluntary
    
  • magnet controllable
    

  [*]rn education/certification

  [*]rn survey:

  • practice environment scales option
    
  • job satisfaction scales option
    
  • job satisfaction scales-short form option
    

https://www.nursingquality.org/

[dudette10, MSN, RN]

Also, It drives me crazy about the patient satisfaction survey. They ask things like,"How often did your nurse respond to your call light" and "How often was your pain controlled" which ARE important, YES. But from what I understand, the only choices the pt gets are ,"Always, Usually, Never." or something to that extent. Well, as a patient, I would think "usually" would be a good response, but the only the we will get paid for are the "Always" responses.

At least that's how it's been explained at my facility. Somebody correct me if I'm wrong... I love a dose of education. :)

I've seen a quarterly survey and the verbatim responses from patients of the survey (not sure if it was the official HCAHPS survey, though). What struck me was that some patients didn't respond to the question being asked. For example, if it was a question about nursing care, they would give their negative response, then complain about the doctor in the verbatim.

A common issue I saw was when a patient was asked "Could you tell me why you did not rate the care as 'excellent'," and the patient would say, "It was very good." When there is a five-point scale, with a small margin of perceptual difference between the top two choices, i.e. "excellent" and "very good," is that difference significant enough to warrant wide-spread reimbursement changes? A response like I gave in the example doesn't sound "dissatisfied" to me!

[jones.rn]

Kroger, this is how the reimbursement works at our hospital as well. We must attain the always rating to receive pay. And you know that is not going to be easy with most patients attitudes.

Freemirini, one would think that a hospital would increase to staff to increase satisfaction. But in my hospital this is sadly not the case. We are still expected to take care of 7 very sick patients, do all the extra "busy work", and get every one pain meds every 2-3 hours