HCAHPS Scores = hospital pay - page 3

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... Read More

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    We are all in big trouble. I can just hear management's flexing of "executive muscles"!
    Esme12 likes this.

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  2. 0
    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



    [font=times new roman,times new roman][font=times new roman,times new roman]the hcahps ([font=times new roman,times new roman][font=times new roman,times new roman]hospital consumer assessment of healthcare providers and systems[font=times new roman,times new roman][font=times new roman,times new roman]) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. hcahps (pronounced "[font=times new roman,times new roman][font=times new roman,times new roman]h-caps[font=times new roman,times new roman][font=times new roman,times new roman]"), also known as the cahps[font=times new roman,times new roman][font=times new roman,times new roman]® [font=times new roman,times new roman][font=times new roman,times new roman]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.
    [font=times new roman,times new roman]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. ...

    [font=times new roman,times new roman]...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....

    [font=times new roman,times new roman]hcahpscontent and administration
    [font=times new roman,times new roman]
    [font=times new roman,times new roman][font=times new roman,times new roman]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.
    [font=times new roman,times new roman]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 ..

    [font=times new roman,times new roman]...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 [font=times new roman,times new roman][font=times new roman,times new roman]quality assurance guidelines, version 5.0, which is available on the official hcahps website, [font=times new roman,times new roman][font=times new roman,times new roman]www.hcahpsonline.org.

    [font=times new roman,times new roman][font=times new roman,times new roman]http://www.hcahpsonline.org/facts.aspx

    [font=times new roman,times new roman]the cahps home health survey

    [font=times new roman,times new roman][font=times new roman,times new roman]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.
    [font=times new roman,times new roman]

    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

    Last edit by NRSKarenRN on Jun 10, '11
  3. 1
    Quote from kroger15
    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!
    herring_RN likes this.
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    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
    JacknSweetpea likes this.
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    its unrealistic to expect "always" as a response, which is why I think they are doing this, so they do NOT have to pay
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    Must get a 5. There are no exceptions. I attended meeting after meeting on this.

    I was told in a meeting the first part of this goes in to effect in July. Does anyone have the facts on this.
  7. 1
    The more I think about it, the more this feels like the No Child Left Behind Act. If you dont perform well, we stop giving you money meaning you cant hire the people needed to do a better job. This in turn is penalizing you further to do more with less.
    Altra likes this.
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    HCAHPS is only one factor in the reimbursement process. The other is core measures. You can see both on


    If your hospital is not a top provider expect your hospital take a bit economic hit. While this effects Medicare patients, your state's medicaid system will follow the federal lead.

    If you are concerned about Health Care and thought the Obama Plan was wonderful, this is direct result of the bill. So if you loved the bill, in my opinion you get what you promoted, so when you don't get a raise be aware that this is the bill you supported.
  9. 0
    The worst part about all of this is that we are being told we cannot coach to the survey. In doing discharge phone calls, I find that the majority of the patients I spoke to did not understand the questions or how the scoring works. While my facility has been scoring well for a while now, our scores have dropped off a bit but its due to lack of patients knowing that a 2nd level rating is equivalent to a 66% which may not be what they are indicating their service to be.
  10. 0
    The focus is on "ALWAYS" as thats the only score being publically reported

    Patients who reported that their nurses "Always" communicated well.
    Patients who reported that their doctors "Always" communicated well.
    Patients who reported that they "Always" received help as soon as they wanted.
    Patients who reported that their pain was "Always" well controlled
    Patients who reported that staff "Always" explained about medicines before giving it to them.
    Patients who reported that the area around their room was "Always" quiet at night.
    Example: Pennsylvania Hospital:


    Check your own hospital scores at: Hospital Compare

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