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Tying Patient Satisfaction to Medicare Reimbursement is Problematic

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TheCommuter has 10 years experience as a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

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Patient satisfaction surveys are important in helping the healthcare facility to harvest data, discover perceptions of the care being rendered, and gather suggestions on how to improve. Since patient satisfaction surveys consist of subjective data instead of objective metrics, the responses should not be tied to Medicare reimbursement rates. You are reading page 2 of Tying Patient Satisfaction to Medicare Reimbursement is Problematic. If you want to start from the beginning Go to First Page.

turnforthenurse has 7 years experience as a MSN, NP and specializes in ER, progressive care.

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I have a question about this...If you receive a questionnaire and don't submit it, does that affect anything? Is 'No comment' seen as 'bad comment'?

I think it only counts if a patient submits a survey.

And I agree, KnitWitch. Forget my professional nursing judgement. Give the somnolent patient their dilaudid, klonopin and benadryl all at the same time because "it's good for satisfaction scores." Let the patient go downstairs and smoke even though we're a non-smoking facility. You're on a 1500cc fluid restriction but it's okay to have all those soda cans and juices at your bedside because it makes you happy. You're diabetic? Go ahead and eat all of those sugar-laden snacks at your bedside, it won't mess with your blood sugar!

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205 Posts; 5,195 Profile Views

An unsubmitted form can't be counted as anything else, I would presume. It is just logged as not received, but not counted as negative.

I concur with that article. The survey should be for internal use only, by someone qualified to know the trivial from the important, and should NOT be an employee or hospital evaluation tool. The lunacy of having pay and performance ratings based on evaluations by probably the very people LEAST-qualified to rate it is one of the key things that infuriated me and really soured me on finishing nursing school. It's outrageous that those probably the least qualified to evaluate my competence as a nurse have so much power to affect my career. It truly baffled me why nursing as a profession is treated the way it is. Your work is essential to good patient outcomes, and a hospital really can't run effectively without nurses. Yet, nurses are treated almost like servants, by everyone. It's nuts. I don't want that job anymore. I was already burned out on the bull_t and waitressing after just one year of diploma school. At least diploma school threw us right out there in the nitty-gritty so that the savvy adults who already have the skills to evaluate an employer and a workplace could see what the big picture really is.

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ParkerBC,MSN,RN specializes in Medical Surgical/Addiction/Mental Health.

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I too think it is a ploy to decrease reimbursement. I am interested in knowing how this will affect staffing ratios. If administrators see a correlation between staffing ratios and patient satisfaction, then maybe adequate staffing will become priority. Let’s see…losing money because of poor patient satisfaction or decreasing the bottom line to add staff to make patients happy. Hmmmm. Let’s be honest, hospitals are becoming Hilton Resorts. While I think it is nice to have a comfortable ambience, it sets expectations higher than what I feel can be delivered unless staffing changes are made.

What do you suppose will happen to the smaller hospitals that do not have the capital to renovate or pay fair salaries?

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TheCommuter has 10 years experience as a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

228 Articles; 27,607 Posts; 316,491 Profile Views

What do you suppose will happen to the smaller hospitals that do not have the capital to renovate or pay fair salaries?
I think a handful of the small hospitals that lack deep pockets/capital will fold up, go under, and close their doors for good as the result of continual monetary losses.

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9 Posts; 931 Profile Views

I think the ship has sailed for me. Now, I am over the shock and dismay and would just like to move on. Does anyone have high scores? Any suggestions on how to answer call lights as soon as the patients would like?

Any suggestions on how to keep a 24 hour facility quiet at night?

Any suggestions on how to keep a 24 hour facility with frequent traffic in and out clean?

Any suggestions on how to teach side effects to people who don't care about them?

I would do anything to have others think my co workers and I do a good job. I know we do.

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Tina, RN has 20 years experience and specializes in Acute Care, CM, School Nursing.

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I began my very first job as a 16 year old high school student. Worked continuously through high school and nursing school. I worked as a RN for approx 5 years, most of that in hospitals. I was home with my kids for years, then went back to the hospital per diem for another year and a half. In all of my years working, from back when I was 16, I never, ever received a "write up". Never had a bad evaluation at work. I consider myself to be a very hard worker.

What made me finally leave my per diem job (and acute care) for good? Last year, I received my first ever write up. The reason: A patient's family told my nurse manager that they felt I "wasn't in the room enough". I got a phone call from my manager, telling me about the family's complaints. Apparently, they were also angry that I wouldn't give the patient a tylenol. 1) He had no orders for tylenol, and I had documented that I tried repeatedly to contact the doctor. 2) The patient was extremely ill and in liver failure!! My nurse manager actually told me that it wouldn't have been a big deal to "slip him a tylenol" to keep them happy. I could not believe what I was hearing! Customer satisfaction at its finest!

I remembered this shift, patient and family clearly. The patient was a DNR, and had many, many issues. The family was furious at the hospital and the doctors over his care. They were not happy campers in general. I knew I was in for it, because I was the only one that was actually right there, in front of their faces. Sure enough, I was right: My first ever write up at work.

PS: That shift was a nightmare: It was a weekend and I was working with one other nurse on a "satellite" step-down unit. No supplies, no CNA. Lots of very, very sick patients. I let the on-call nursing supervisor know that the situation was completely unmanageable (repeatedly). Unfortunately, I never filled out the form, protesting the unsafe assignment. I really should have, and I still kick myself. But, like a fool, I didn't want to waste time finding it and filling it out. There was just too much to do... *sigh* I still miss bedside nursing, but I will never go back. It's not worth my sanity.

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serenity1 has 7 years experience and specializes in labor & delivery.

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I've been a nurse 3 years this month. Getting away from the bedside soon as I can. We have been sent to "charm school" type classes to learn how to communicate and impress our patients with everything but good nursing care, all for the sake of reimbursement. My skills and knowledge make no difference at my job as long as I make the patient feel as if she has been residing at the Ritz with me as her concierge. Not what I went to school for at all.

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StNeotser has 10 years experience as a ASN, RN.

963 Posts; 25,068 Profile Views

I do believe that the posters who have said they think it's to cut reimbursement rates are right. Obviously people aren't happy when they're in the hospital. Reimbursement should be paid on medical outcomes, not "my TV wouldn't get the sports channel and I waited ten minutes for a soda"

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15 Posts; 1,778 Profile Views

I have been saying the same thing for a few years now. I too have witnessed numerous times where the nurse who provides the most competent care but does not coddle the patient gets the most complaints. I have seen patient's and their families praise nurses and doctors who give inferior care just because they smile and give repeated scripted responses. Eventually insurance companies will implement this protocol so they too may cut payments. This in turn is going to drive up healthcare cost.

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1,853 Posts; 20,879 Profile Views

I too think it is a ploy to decrease reimbursement. I am interested in knowing how this will affect staffing ratios. If administrators see a correlation between staffing ratios and patient satisfaction, then maybe adequate staffing will become priority. Let's see...losing money because of poor patient satisfaction or decreasing the bottom line to add staff to make patients happy. Hmmmm. Let's be honest, hospitals are becoming Hilton Resorts. While I think it is nice to have a comfortable ambience, it sets expectations higher than what I feel can be delivered unless staffing changes are made.

What do you suppose will happen to the smaller hospitals that do not have the capital to renovate or pay fair salaries?

They won't change the staffing- they will just can the "low performers" and get new ones, since nurses are a dime a dozen....:banghead:

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1,853 Posts; 20,879 Profile Views

I think a handful of the small hospitals that lack deep pockets/capital will fold up, go under, and close their doors for good as the result of continual monetary losses.

This just happened recently where I live.:(

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That Guy has 6 years experience as a BSN, RN, EMT-B and specializes in Emergency/Cath Lab.

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I see this more as a "Oh we know people hate the ER times, hate being sick and are demanding as hell" so therefore how can we save some money...Thats right lets ask them stupid questions and then say you have to score the best on all of them to get paid for it.

I wish I could pay less when my food takes too long to get to me

Or the waitress is rude

Or when the lines are long to get checked out at the grocery store

or fill in the blank here.

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