Patients grades to affect hospital medicare reimbursements

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    http://www.nytimes.com/2011/11/08/he...ursements.html

    If this becomes the real deal, I believe all of our gooses are cooked. I am going to be REALLY glad to be OUT of hospital based care in a year or two.

    I believe this is an impossible goal, given the entitlement mentality of so many patients. I am really shocked that Obamacare is going to wrestle with this and tie it into reimbursements.
    Sanuk and lindarn like this.

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  2. 63 Comments...

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    I posted on this issue a couple of days ago in another forum, so I am basically going to copy and paste my same response over here.

    The mingling of customer service and patient care personally disgusts me. Healthcare facilities are designed to provide patient care. However, they are not in existence to provide customer service. There's definitely a difference between nursing care and customer service. Keep reading to see my point.

    The chef at the Hilton will provide excellent customer service by preparing a juicy steak and baked potato covered with several pats of artery-clogging butter for the patient with coronary artery disease. The hotel cook will go out of his way to display excellent customer service by baking an entire sugar-laden red velvet cake for the noncompliant diabetic patient. The bellhop at the Ritz-Carlton will provide excellent customer service by escorting the COPD patient to a lush patio where smoking is allowed. As long as customers are paying for the services to be rendered, employees in the hotel, hospitality, and tourism industry will do these things for the sake of great customer service. After all, they want the 'paying customer' to return someday.

    It is crucial that patients and visitors realize that the hospital is for patient care, not customer service. It is scary that customer service scores on surveys will soon dictate reimbursement rates for healthcare facilities.
    arl50, roofrn, nursenotamaid, and 10 others like this.
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    Am so frustrated with the idea of this that i'm replying twice to my own thread, LOL.

    For one thing, a LOT of people will NEVER award anyone a 9 or 10 if they are given the choice. Like the man in the article who said his care was "good" but he just would never award ANYTHING an 9 or 10. Some people are just curmudgeons that way.

    I just want to say ... it seems NOW we have politicians in addition to administrators driving care and calling the shots. I believe this will DESTROY many hospitals and result in even less care to go around, at the same time, increasing the number of patients in line for care. How sad for our already ailing health care system.
    roofrn, Sanuk, SweettartRN, and 3 others like this.
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    As long as customers are paying for the services to be rendered, employees in the hotel, hospitality, and tourism industry will do these things for the sake of great customer service. After all, they want the 'paying customer' to return someday.

    Right. However, in the case of the future of healthcare under this law, many of these patients who have all this control over what ratings they give will NOT be directly paying, will NOT have ANY idea as to the costs associated with their stay ...yet THEY will be in control and the ultimate arbiters of whether a hospital survives or not financially.

    A truly insidious prospect. I just do not believe patients anywhere can be pleased to this degree, 100% of the time.

    This also throws any emphasis on quality clinical care right out the window.
    Sanuk, RNLaborNurse4U, and lindarn like this.
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    In addition, patients who use emergency departments inappropriately are going to give the ED poor scores on a customer service survey, even though the ER might not have done anything wrong. Patients who visit the ED for nonemergent issues (sniffles, skin tears, etc.) are going to be frustrated at not being seen first, and will consequently mail in a survey with low satisfaction scores.

    This results in low reimbursement rates for the hospital, which causes the hospital to cut more staffing and supplies, which leads to even more waiting (or closure of the facility if the reimbursements continue to dwindle).

    A hospital's solvency should not depend on patient satisfaction surveys. This is a terrible idea that will backfire.
    arl50, MaleBSNRN, Sanuk, and 8 others like this.
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    I make a point to tell my patients that if the hospital is given low scores, not because of the medical care but because they didn't like the sheets or the food or the wallpaper or the cable on the TV, it could lead to the hospital being closed by medicare and they would have to travel 50 miles to the next hospital. I tell them if they have a problem, tell us now, and we'll address it if it's something we can fix.

    Usually telling them they won't have an ER to get their weekly fix -- er, primary health care at stops them cold. I had one say, "They can't do that, they can't close the only hospital around here!!" I told him, "no, they can't, YOU can."
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    I am disgusted as well that the reimbursement is going to be linked to "customer satisfaction". Our society is full of people who feel entitled to every little thing. And yes, I hate to say it, the poorer the population, the more demanding and "entitled" they act! My private insurance patients are the ones who are far less demanding and acting entitled --- oh and they are also the patients who are more grateful for the fabulous medical and nursing services that they receive!
    strn96 and Lee505 like this.
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    I mean -- what are we going to do -- close ALL hospitals that don't receive superior ratings? Is this the final outcome? There will not be a hospital LEFT with open doors.

    Who is coming up with proposals like these? Have they EVER set foot in a hospital or on a patient care floor?

    Sure -- close them all done except one per city. Then see what happens. No care for ANYONE, except whom??

    I understand the need for competition and Press Ganey scores, etc. Sure - try to do your best to outshine your competition -- a noble goal. But to tie it to reimbursement?? It just goes beyond the common sense test.
    bigsick_littlesick likes this.
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    And yes, I hate to say it, the poorer the population, the more demanding and "entitled" they act! My private insurance patients are the ones who are far less demanding and acting entitled --- oh and they are also the patients who are more grateful for the fabulous medical and nursing services that they receive!
    I have to say I don't really see it as a poor man/rich man issue, but more just a personality issue. There are many folks out there than CANNOT be pleased. Many also have serious mental/depression issues and nothing will ever please them, either. I've taken care of poor patients who are extremely grateful -- i've taken care of wealthier ones who had the "entitlement" attitude. To me it's about personality in general -- so how do we as nurses control THIS?

    And you KNOW who this is going to fall straight on -- THE NURSE.


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