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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 3 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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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!

This has happened in other areas, too. We were basically told by management that it doesn't matter if a patient is somnolent, if they are due for their pain medicine or Xanax or whatever, you are to give it. Why? Because it's for "patient satisfaction." Screw your professional nursing judgement.

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Thank you for the wonderful article and all of the thoughtful comments. All of the above has weighed on me quite heavily already and I'm only in my second of four semesters of school. It seems as though many of us are stuck between a rock and hard place. The hospital is promoting "customer service" as in a hotel atmosphere, professors are promoting "therapeutic communication & safety," third party payers are demanding "safety & efficiency," and patients are demanding everything. It seems as though it all boils down to the almighty dollar. What a sad situation when it comes to dealing with human lives - humans that could our mother, father, brother, sister, etc.

How can we as nurses be compassionate and effective nurses when we are constantly watching our backs because we're worried about being written up and we're run ragged? How can we be genuine and give of ourselves when we are told to give scripted replies? How can we ensure patient safety when we are short-staffed over over-loaded with patients?

I have never been a political person, but I feel so strongly about all of this, I am wondering, "How can I make a difference? Who can I talk to? How can I learn more? How can I be involved in the process?"

I listened to an exasperated nurse explain to my clinical instructor that she was frustrated with patient stay limitations imposed by the XYZ insurance company. When I heard this, I thought "Who at the insurance company is making these decisions? Who are they? How much are they paid? What are their credentials? What's the bottom line of that company? How much do the top dogs make who probably have MBAs and no medical background?" I then said, "I know what I'll do when I graduate! I need to go undercover at XYZ and find out what the heck is going on!!"

Well, I must get back to the crushing textbook on my lap and turn my thoughts inward to the next hurdle lurking on Tuesday morning.

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Ginger's Mom has 41 years experience as a MSN, RN.

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Every CMS measure has open comment before it becomes Rule. Anyone can comment, yet I would bet not one had posted a response on the CMS web site. AT insurance companies it is a medical director who is a physician making decisions.

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370 Posts; 5,971 Profile Views

Great article, and I agree with you 100%. Too many times have I witnessed a client be given superb hospitality during the stay. We setch sodas, magazines, anything to try to keep the score high. We even goes far to say "Thank you for choosing _________, we hope that you will give us all 5's" Though, at discharge you find you now have an angry pt because they have been prescribed torodal rather than dilauded. Guess what we're getting on the cards.

Second note, our healthcare system has now set itself up for pt satisfaction that we will have to start saying "Welcome to the Hilton". It's a beast in the making. Thank you to the government.

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sistasoul specializes in neuro/ortho med surge 4.

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What is a CMS measure?

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Second note, our healthcare system has now set itself up for pt satisfaction that we will have to start saying "Welcome to the Hilton". It's a beast in the making. Thank you to the government.

too late - it's already started.

What I'd like to know is why are hospitals sooo stupid that they actually think they will get glowing scores even if we serve the pt trays on silver platters with a personal waiter?? This is a no win situation,and I can't wait to see the aftermath when hospitals will not be getting paid for any services. What , are they going to can everyone that has to do with pt care and perception? They won't be canning the docs; they'll be canning the nurses. Heck, they probably won't even can the ancilliary staff. Seriously, after a few months/years of not getting paid( because medicare will eek out of having to pay) how long do we think hospitals will hang around for this???

More food for thought..

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Morainey is a BSN, RN and specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

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I wish that they would factor in the fact that you can't please everyone. Lately - and I don't know if it's the long winter, or what - but we've had some real humdingers of miserable folks. I don't mean miserable as in they're upset because they receive bad care, they're miserable and yell at the nurse. Then the CNA. Then at their wife or husband or dutiful niece or nephew or daughter or son. They get mad they we don't have Sweet 'n' Low but we do have Equal, Splenda, and sugar.

I had a patient who was upset that he was "woken up too much". This is someone who had an elective joint replacement. We do vital signs twice during the night shift. So being an eager-to-please nurse, I waited until the lab come around to draw his blood at around 5:30AM, went and found the CNA to grab vitals while I gave his meds, and we all three went hustling in to his room to attend to his needs quickly. He got upset that there were too many people in his room. :mad:

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1,853 Posts; 20,874 Profile Views

Like someone else said,I'm quite confident that medicare or who ever knows that the scores will suck, so they wont have to pay, and therefore line their own pockets.

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oldenurselady has 25 years experience and specializes in ob.

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Like someone else said,I'm quite confident that medicare or who ever knows that the scores will suck, so they wont have to pay, and therefore line their own pockets.

Yup!!! Not to mention the whole industry of the satisfaction survey wonks. No one at Press-Gainey or NRC-Picker is getting poor from all of this nonsense! Someone complained they did not like being on isolation and it made it in to the survey comments our managers pass out via email. really??? What were we supposed to do about that one?

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1,853 Posts; 20,874 Profile Views

yes- no win. had to move a pt from a private to a semi for a pt and family in which the family was very large( like 20 people would be in the room at one time) and that pt with the large family was possibly going to be put on comfort care. The family was very grateful. I bet we might even get a good score on that one. Only to be cancelled out by the person who was upset that they got moved.

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

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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.

So, these community hospitals will close their doors, creating a more compounding effect on rural healthcare. Who comes up with this crap?

Sorry for the double post, but I forgot to quote The Commuter :-)

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

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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:

I suppose you are correct. It's sad!

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