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

  1. by   That Guy
    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.
  2. by   Ginger's Mom

    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.
  3. by   SouthernCarolinaRN
    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.
  4. by   NRSKarenRN
    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
  5. by   dudette10
    Patients who reported that they "Always" received help as soon as they wanted.
    Uh-oh. The speed of "service" is objectively measured even at fast food restaurants, and that's an assembly line-type service, not a service that requires prioritization of need.
  6. by   Ginger's Mom
    Before, any of these measures became law, you have the right to make comments, to Medicare. How many complaining now took the time to post their thoughts? The time to complain is before the measures are intacted into law, not when you don't like the results.
  7. by   tmgrivetti
    HCAHPS is under the auspice of CMS (Medicare and Medicaid). I am quite sure this is a given for this discussion.

    70% of hospital reimbursement will be for patient outcomes and 30% will be based on patient satisfaction. Beginning in 2013, the reimbursement phase begins. Organizations in the 75th - 90th percentiles with actionable increases and positive changes in their overall scores, stand to gain the full reimbursements plus a potential bonus. Those organizations below the 75th percentile will lose reimbursement.

    All of this is starting with reducing DRG related codes up to 2% by 2017; thus each year a reduction of .25% in reimbursement. I have some very easy and understandable documents but unable post here as they are pdf files.

    I would highly suggest joining LinkedIn.com and then joining some of the groups. The StuderGroup has a done a remarkable job as providing this information as well and you might be able to access some: www.studergroup.com

    The other is the Advisory Board www.advisory.com. However, your organization needs to be a member to access and you have to access to various groups.
  8. by   glasgow3
    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.

    The movement to tie Medicare reimbursement to HCAHPS was clearly underway in 2006-2007....well before Obama was elected and well before his healthcare reform bill was signed into law.

    Initiatives of this type take a great deal of time to fully implement.
    Last edit by NRSKarenRN on Jun 15, '11
  9. by   NRSKarenRN
    Medicare started this while George Bush President...

    HCAHPS Development, Testing and Endorsement
    [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]Beginning in 2002, CMS partnered with the Agency for Healthcare Research and Quality (AHRQ), another agency in the federal Department of Health and Human Services, to develop and test the HCAHPS survey. AHRQ carried out a rigorous scientific process, including a public call for measures; review of literature; cognitive interviews; consumer focus groups; stakeholder input; a three-state pilot test; extensive psychometric analyses; consumer testing; and numerous small-scale field tests. During this process, CMS provided three separate opportunities for the public to comment on HCAHPS, and responded to well over one thousand comments.

    [FONT=Times New Roman,Times New Roman]In May 2005, the HCAHPS survey was endorsed by the National Quality Forum, a national organization that represents the consensus of many healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. In December 2005, the federal Office of Management and Budget gave its final approval for the national implementation of HCAHPS for public reporting purposes. CMS implemented the HCAHPS survey in October 2006, and the first public reporting of HCAHPS results occurred in March 2008. The survey, its methodology and the results it produces are in the public domain.
  10. by   Texasnurse81
    Not only is my facility stressing this, they are stressing out all the nurses. It is all about the patient satisfaction scores at my place of work. I always felt that nurses gave good care and had great positive attitudes and the patients would always comment on this. now all the nurses i work with are burned out and getting bad attitudes because we are constantly told on a daily basis what the scores are. They have implemented 1 hour rounding, bedside reporting, administration rounding, rounding with every doctor (sometimes your patients have 6 or 7, and they take thier time) and a no pass zone meaning if a call bell is going off we are required to stop what we are doing and go answer the call bell any and every time it goes off, for 40+ patients even if not your patient, and assist them or find their nurse/aide etc. if we do not do any of the above 100% of time we get into trouble or wrote up. If unable because of codes, patient demands, medical concern, administering pain meds, etc, we have to explain ourselves (shouldn't have to do that). Every time the scores are down another nursing intervention is added for us such as the ones above (this happens very regularly too). Nothing is ever taken away. We are all stressed out and job dissatisfaction and morale is at an all time low. it is no better with the competing hospitals nearby, they are all modeling after one another. .so feels pretty hopeless. I am all about pleasing my patients and taking care of all their needs and truly making them happy, but does it have to be at the cost of placing so much stress ,pressures and negativity on the nurse for the scores. when the scores are down, we are blamed, and told we are not doing the intereventions above, and then they add more interventions. Many at my work are not only considering quitting, but finding other careers and geting out of nursing. But what other jobs are there?? :-/
  11. by   morte
    ...hmm I was taught in Jr High science class that the ONLY time to use the words "never" or "always" was when you said, NEVER use the word ALWAYS.......
  12. by   babowman3RN
    Quote from A&OxNone
    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.
    Yes, Always, Usually, Sometimes, and Never are the answer choices. I think it is absurd because of course "Always" is the right answer. Which is all just a scheme becuase NOTHING is ever ALWAYS!

    Ugh, this is why I'm more and more disgusted with heathcare and this career. All this government and politics has drove nursing into the ground.

    Basically, if you want better scores? Hire more nurses and give us less patients.
  13. by   mimi397
    The always is an unrealistic answer. The more tasks you pile onto a nurse along with taking away critical resources (e.g., census low, not qualifying for another nurse or a tech gets sent home), the less likely an "always" response is given. Administration seems to not understand that there are patients who require more bedside care than others. Total care patients who have Cdiff along with a possible UTI and are voiding every 5 minutes and need the bedding and gown changed are a lot longer. Taking away the extra resource that was there to help in whatever manner is critically influencing disappointing outcomes. I'm a frustrated nurse with patients' satisfaction tied to HCAP scores. It's just not a realistic situation. Walk in the nurse's shoes for a day and come up with some options that will HELP a nurse attain these scores instead of piling on more tasks that are deemed more important than patient care. Instead of sending home the nurse, keep the nurse to tech or answer phones, call lights. To have a dedicated individual to ALWAYS answer a call light will most definitely improve patient satisfaction. With that satisfaction of ALWAYS comes reimbursement that will more than likely cover the expense of the nurse/tech/secretary, whoever. But when you are in the middle of taking care of your own patients and the call light is going off, how ridiculous is it to leave what you are doing to answer to only not be able to respond appropriately to that call because you have to return to your own patient. Makes no sense nor is it safe. And it will only make your own patients feel like they are not a priority which is not true. There seems to be no answer to HELPING the nurse, just more work we are required to do.