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HCAHP Scores

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Hello, I am a nursing student graduating in May, 2015. I have been a CNA for 8 years and work in the ICU until I graduate and find a RN position. I wanted to know what other nurses thoughts are regarding HCHAP scores/patient satisfaction. I sometimes have a hard time with them because a facility could literally save someones life but because they were perhaps a little late on bringing in that patients pain meds a facility could get a bad HCAHP score, causing the facility to lose out on payment. I know I don't completely understand all of the ins and outs of HCAHPS but I was just curious what other people thought about them.

I agree that a patient needs to be treated with respect, cared for in a timely manner, and have details about their care explained to them by not only nursing staff but also the physician, etc. I know it would take a lot of displeased patients to bring down a score sufficiently enough to prevent payment. However, a service was rendered, why shouldn't that service be paid for?

I'm just curious on others opinions about the matter. Perhaps this is an area that I need to familiarize myself more with as I step into the nursing role soon. Thanks for your input!

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

They won't totally lose out on payment, but it may be reduced by 2%. Although I may be confusing this with HEDIS measures.

Okay just googled and the above statement is correct.

Edited by klone

I don't work in acute care but it's relatively easy to have positive surveys returned where I work. The usual things our patients report are legit and could have been avoided. The positive things they remember are staff knowledge/skill and feeling cared for which are easy to provide in home health.

I don't know why nurses insist on working under conditions where they work short for the acuity and patients complain about ice (I've never had one come home and report such a silly thing, their complaints on average are reasonable and it's usually one nurse who causes a negative report because they believe it's worth reporting, it's less common that they were unhappy with all of the staff, except in rehab and that's about a 50/50 mix).

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

I strongly dislike them. Unhappy people are much more likely to respond to the surveys and if you have a run of drug seekers that won't be satisfied until they get enough Dilaudid to go into respiratory arrest, your pain scores will stink. And honestly some patients will never be happy. According to the type of patient population on the floor, you will find the scores excellent one month and terrible the next. How can that be an accurate assessment tool then, when the same nurses are providing the same care but the scores are a yo-yo. Alot of the scores are so subjective it can be ridiculous.

dudette10, MSN, RN

Specializes in Med/Surg, Academics. Has 10 years experience.

Also, it doesn't take a lot of displeased patients to affect reimbursement; all it takes is not enough "excellent" ratings. That means that every single one of the patients could rate their hospital experience as "very good," and reimbursement would still be cut.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Personally I am all for CMS creating an incentive to staff properly and provide adequate support to nursing staff.

What the HCAHPS questions are basically asking is whether or not the hospital is providing it's staff with enough time and support to provide a basic standard of care. It doesn't define what that standard is, it just looks at whether or not a hospital is at least keeping up with a low-end average set by other hospitals. In other words, it makes no difference if overall patients tend to rate hospitals poorly, since reimbursement isn't based on your score, it's based on whether or not your score is significantly lower than the average score.

dream'n, BSN, RN

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 28 years experience.

Yes, but it doesn't create an incentive to staff properly or provide staff support. When the scores are not to administrations liking, they pile more and more documentation on the staff they have, therefore further burdening the staff and lessening their ability to provide hands-on care. Or they start scripting; "I hope you'll find everything EXCELLENT", "I have the time because I want your stay to be EXCELLENT."

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Yes' date=' but it doesn't create an incentive to staff properly or provide staff support. When the scores are not to administrations liking, they pile more and more documentation on the staff they have, therefore further burdening the staff and lessening their ability to provide hands-on care. Or they start scripting; "I hope you'll find everything [u']EXCELLENT[/u]", "I have the time because I want your stay to be EXCELLENT."

Hospitals are free to try and improve their scores in whatever they want. If they chose to do something that is unlikely to improve their scores or even make them worse then they get penalized (disincentive), if they chose to do something that will actually improve their scores (better staffing, better support) then they get financially rewarded (incentive).

No one likes having their performance judged, but it's going to happen whether the facility does a survey or not. At least a survey gives the facility information on which areas need work. Having patients/families posting complaints on social media or telling all their friends and relatives about the horrible care they received at General Hospital does not help the hospital improve.

It's true that someone is more likely to return a survey if they were exceptionally unhappy with the facility. The same came be said for the person who is exceptionally pleased. The people in the middle of the bell curve are the ones least likely to respond.

There are ways to insure a greater response to surveys. One hospital system where I live phones the patient rather than mailing a survey. A nurse calls a day or two after you are released. They ask how you are feeling. Do you have any questions about your medications? Do you have any questions about caring for your incision or drains, etc. They make sure you know what conditions would warrant a call to your physician and what should prompt a trip to the ER. They just review the same type of stuff they do in your discharge teaching, except it's after you've had a day or two on your own and it's not as rushed as the discharge teaching. That's when you think of things you should have asked at discharge. After addressing your questions/concerns, they ask if you would be willing to answer a short survey. Of course everyone says yes to the survey. I've seen their survey results and they are always extremely high. I've been the patient answering the survey. I was so impressed that they would call to make sure I understood the post-discharge care! I was so impressed with their thoroughness in every aspect of my care from pre-admission to post-discharge. I was also impressed with how well they communicated the plan of care, what the patient could expect, etc.

I've also been the patient giving a bad review of a facility. Most of my complaints stemmed from their very poor communication with me and the very poor communication between the providers. When they made a mistake they tried to hide it. When I had a complication that was related to the procedure they had done, they denied it was related. When I refused a test, they did it anyway. (I refused the test because it had poor sensitivity and poor specificity and would not provide any additional information.) The message from this - communicate honestly and openly with your patients. Treat your patients with courtesy and respect. Honor the patient's treatment decisions. If you do this, the majority will give you a positive review.

Of course there are going to be people who are never satisfied, but a well designed survey / statistical analysis should account for this. No one expects all surveys to be glowing responses. They expect a facility to do as well as or better than other similar facilities. They also expect them to show improvement in poor performing areas. If most hospitals have 95% of their patients say they would recommend them to a friend or family, but General Hospital has only 75%, then I don't think they just had more of the grumpy, unhappy people than other hospitals.

There are always a lot of complaints about HCHAP patient satisfaction surveys, but have you ever thought about why these surveys were mandated? Government organizations don't usually mandate something like this unless there were a lot of very unhappy constituents complaining to their representatives.

ixchel

Specializes in critical care.

We have a private company do satisfaction surveys (I guess with the hopes of gauging CMS ratings and finding holes to improve on) and we review them during monthly staff meetings. I can't tell you how often people complain about food and toilet paper (not that they run out, mind you). Always several in every batch.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Here's another way to look at HCAHPS; should patients receive information about new medications they are given in the hospital? Should hospitals that fail to provide that information at a significantly higher rate than other hospitals receive the same payment even though they aren't doing what they're getting paid to do?

ixchel

Specializes in critical care.

Here's another way to look at HCAHPS; should patients receive information about new medications they are given in the hospital? Should hospitals that fail to provide that information at a significantly higher rate than other hospitals receive the same payment even though they aren't doing what they're getting paid to do?

I absolutely believe with all of my heart that the things hospitals are rated for on CMS surveys SHOULD be assessed. Where I struggle is the requirement for answers to be "always". For instance, when you pushed your call bell, how often did you get care as soon as you needed it? I would bet you money 99% of people answer usually, if the unit is good at responding to call bells. Expecting "always" on some of these questions might be equivalent to expecting a unicorn for your birthday. Even with your best, fullest effort, giving people that "always" is often not possible.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

I absolutely believe with all of my heart that the things hospitals are rated for on CMS surveys SHOULD be assessed. Where I struggle is the requirement for answers to be "always". For instance, when you pushed your call bell, how often did you get care as soon as you needed it? I would bet you money 99% of people answer usually, if the unit is good at responding to call bells. Expecting "always" on some of these questions might be equivalent to expecting a unicorn for your birthday. Even with your best, fullest effort, giving people that "always" is often not possible.

If "usually" is a common response to that question in all hospitals then your hospital won't lose any reimbursement if your patients also answer "usually". Even if patients at your hospital frequently answer "never" to that question your hospital still won't lose money if that's how patients at most hospitals also answer the question.

HCAHPS isn't based on how well your hospital does on the survey, it's based on whether or not your hospital is significantly worse or significantly better than other hospitals, no matter how negatively patient might answer the questions overall.

Thank you for all of your input. It helped clear up some of the confusion and gave me a better understanding.

Seaofclouds, BSN, RN

Specializes in CCRN.

Some of the responses to the surveys I've seen have offered very good feedback, some stated things that were beyond our control. Our case manager goes over the survey with the patient before they leave (most of our patients go to another facility when they leave us). We have had patients tell us everything was great and they loved it (answered top scores on all the questions up until the end). Then, when it comes to the overall rating (which is a 1-10 scale) and the willingness to recommend rating (which is a 1-4 scale), they give us a 7 and a 3 respectively. While these aren't horrible, they aren't what we aim for either (9-10, 4). When we ask if there was anything we could have done to receive a 9-10 and a 4, they tell us they wanted a private room and we didn't have any (which they new prior to agreeing to come to our facility). Stuff like that is painful to hear because we can't do anything about that (at our level). It would be a corporate decision to move us to a new location with private rooms (we rent our space from another facility). Those are the situations where reimbursement based on scores scare me.

Edited by Seaofclouds
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