Well, there goes our bonus!

Nurses General Nursing

Published

Our bonus at work is based on the lovely patient surveys that new pts get (formulated through CMS, blah blah blah). We had a very entitled older teenage pt and mother in the office recently who would NOT get off the phone. Pt just stared at me when I asked for name and DOB, and I had to ask mom to verify pharmacy, meds, and allergies because pt was too busy texting. (Someone had texted pt about what so-and-so had posted on Facebook about someone else's brother and they can't mess with them--the drama!). When I was escorting them out after the visit, pt and mom stated MD was very rude, had no bedside manner, and was horrible. This is our best MD, one of the founding partners of the practice, and the most popular one. Pt was still jabbing away at her phone and snapping at me about the Facebook post. When they left (after I apologized), I asked MD what happened. He'd asked pt and mom 3 different times to put the phones down so he could get the H&P and do the exam--and pt refused. Now, she'll get a survey and we'll get dinged for low scores for pt's own behavior. I HATE those surveys. We had one survey give us horrible reviews and said Dr. Smith was incompetent, and we don't have a Dr. Smith in our practice (it was that pt's cardio!). Can we make those surveys disappear, or at least be able to defend ourselves against the horrible ones? Grrr.

Specializes in Adult Nurse Practitioner.

According to CMS, next year, providers (all forms) will be compensated depending on "satisfaction scores" that include everything from how quickly their phone call took to be answered to how smoothly did the check-out process go and EVERYTHING in between. If your "visit" score is low due to ANY of the problems, the provider will not be reimbursed at the usual scale but receive a "ding". If the score is high...the provider will receive the usual scale and be marked for a "bonus" reimbursement. This is to be done by patients who "agree" to be contacted via email to do this. Have not heard about the other 90% who most likely won't want to be "bothered".

Chin up, she will probably be too busy texting to take the time to fill our and return the survey.

Unless it's sent to her electronically, then she's sure to get it completed in between texts.

Specializes in Critical Care.
According to CMS, next year, providers (all forms) will be compensated depending on "satisfaction scores" that include everything from how quickly their phone call took to be answered to how smoothly did the check-out process go and EVERYTHING in between. If your "visit" score is low due to ANY of the problems, the provider will not be reimbursed at the usual scale but receive a "ding". If the score is high...the provider will receive the usual scale and be marked for a "bonus" reimbursement. This is to be done by patients who "agree" to be contacted via email to do this. Have not heard about the other 90% who most likely won't want to be "bothered".

CMS doesn't require that outpatient clinics be reimbursed based on value based purchasing, so the scores won't be affecting reimbursement. CMS is going to start requiring that outpatient clinics take part in CAHPS surveys to get fully reimbursed, for the purpose of patient's being able to compare clinic scores, but so long as a clinic participates then their reimbursement isn't affected regardless of the scores.

Muno - can't they kind of get wrapped up in it via MIPS and the ACO versions?

Specializes in Critical Care.
Muno - can't they kind of get wrapped up in it via MIPS and the ACO versions?

It certainly could in the future if CMS decides to include satisfaction scores in the 'quality' section of MIPS, but at least based in their currently active and proposed methodologies, CMS doesn't include satisfaction score as either a mandated or optional reimbursement criteria.

We do have a no-phone policy and it's posted in the waiting room.

Our practice is part of a huge healthcare system that includes hospitals, urgent care, long-term care, and medical offices. Our Press Ganey or GCAHPS or whatever it is is reviewed by CMS, and our bonus allotment comes from CMS instead of the healthcare system itself, so if the physician office side doesn't make the minimum "would you recommend this practice" number, CMS doesn't give money for bonuses.

Anyway, I was shocked when pt complained about the provider because he really is our best provider, I was irritated that pt was so entitled as to ignore the physician repeatedly when he was trying to do the visit, I was annoyed that pt griped about the provider being 'rude' because the PT wouldn't follow instructions, and it's annoying that those stupid surveys carry so much weight. When I apologized for the bad visit, I asked if there were any questions they felt the provider didn't address and offered to get the provider back in the room and that's when pt went off about how rude he was.

Mind you, pt was still texting and even took a phone call while doing all this, snapping at the person on the phone that they'd call back, and about gave herself whiplash from flipping her hair side to side. Pt had walked in with a chip on their shoulder and started the nasty attitude with me before the provider went in the room.

I'm glad pt went somewhere else for a second opinion. :)

Specializes in Pediatrics Retired.

I work pool in a pediatric urgent care. We have a zillion inch flat screen mounted on the wall with streaming movies, several playsets, and even have a Keurig and water for the parents in the waiting room. What a joke...we still can't comply to the outrageous demands. As far as I'm concerned, you don't need a patient satisfaction survey when you open a chart and the screen is filled with previous visits. If they weren't happy they would not come back.

This doesn't surprise me in the least-gone are the days of common respect, civility, decency, mutual respect, tolerance, and pride. Go to any public area and this behavior is on full display-look at the way some people dress, talk, act.... I'm sorry to say, but being 'trashy' is the new norm today and we as a society, have sunk to a new low.

Specializes in Case Manager/Administrator.

I am not really sure of when we lost control over our work (healthcare) environment but I am so very glad I do what I do now.

The thought of me returning to hospital nursing makes me have the dry heaves. I applaud you all who work in that environment, I just could not do that.

It comes down to who is making the decisions and monies. I am sometimes perplexed at my profession, at decisions/policies/regulations coming forward, without it appears a thought to those who have to carry out those decisions.

CMS has changed so very much and I can see a need for patient safety/satisfaction but we have taken it too far and, once you open up Pandora's box you cannot take back these entitlements easily. Trying to please everyone is taxing, it reminds me of working with Behavioral Health patients who have an Axis II diagnosis (personality disorders) those are the hardest patient to take care of and most nurses do this on a daily basis.

I am a snarky person, I just come by this naturally, I would fail in the hospital setting nowadays.

If that was me in the ED with the teen on the phone and mom standing by I would have placed them back out in the waiting room with instructions that when they are available to answers questions without interruptions of cell phone use then please let us know, and I will see if the provider is available then.

This behavior is everywhere not just medical.

Sometimes my passive aggressive side shows and when I am purchasing something and that checker is on the phone I will hold my items back until they get off the phone, I deserve to be treated like a human being and will command that. I do not want to be treated like a moment to be passed over whether I am working with patients or in my personal life. It is not respect, but just a human interaction that needs to be acknowledge.

Specializes in Urgent Care, Oncology.

So we have a policy that we step out if the patient is on the phone or answers the phone in the bay. We tell them that we don't want to violate HIPAA as we don't know who on the phone might overhear the conversation. Luckily, management backs us up with this. 95% of the time they hang up the phone and it is no problem but we do have the occasional person who moans and groans.

So ... I was in the (often hated) Performance Improvement Dept. for quite a while (ten years) in 3 large hospitals. As someone who cared a lot about how data was collected, analyzed, and presented, patient satisfaction scores floored me. When I started, it was mailed surveys - the response rate was well south of 0.1%. At one point, a colleague and I presented the confidence interval of the patient satisfaction scores to our ED (who was getting hammered as they vacillated between the 3rd and 95th percentile for any given month or quarter) and Patient Satisfaction officers. Not surprisingly, we had a 95% confidence that the ACTUAL scores (especially monthly) were somewhere between 0 and 100.

I guess it wasn't surprising that the execs did not take kindly to this analysis. But it was the statistical truth.

Specializes in Psych, Addictions, SOL (Student of Life).

What's a bonus?

Hppy

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