January 20th, 2012
By Jennifer Olin, BSN, RN
HCAHPS, the Hospital Consumer Assessment of Healthcare Providers and Systems, has been underway for almost a year now and the first official results are about to be tallied. The initiative will reward hospitals for the quality of care they provide to people with Medicare and is supposed to help reduce health care costs as part of the Affordable Care Act.
The Hospital Value-Based Purchasing program marks the beginning of an historic change in how Medicare pays health care providers and facilities. For the first time, 3,500 hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide. Much of that quality responsibility falls on the shoulders of the nursing staff. Nurses are the usually the largest number of employees in a hospital and they are the face of day-to-day care.
The first performance period surveys are scheduled to end March 31. Payment adjustments will begin for patients discharged as of Oct. 1, 2011.
Cheryl Clark, writing for HealthLeaders Media, says, "What makes many hospitals and clinical nurse managers most nervous, however, is that the patients responding to these surveys must reply 'Always,' in order for the hospital to get credit for high quality patient experiences. Responses 'Sometimes' or 'Usually' aren't going to cut the mustard."
And it's not just administrators and managers who are talking. Just this last weekend the people gathered around my pre-football brunch table were heartily involved in not just bacon and French toast but HCAHPS discussions. As both nurses and physicians we know there is rarely an "always."
"I don't remember a patient ever saying everything about their stay in my hospital was 'always' perfect," said Marrice King, RN, BSN, nurse educator. "My hospital gives out a lot of surveys, and really, how often is the answer "all or nothing?
"Questions like, 'Did your nurse wash their hands in front of you?' can be a problem," King said. "Sinks can't always be seen from the bed, or my nurses wash their hands in the hall or use hand sanitizer on their way into the room. Now, I tell my nurses, walk into the patient's area still drying your hands with a paper towel or rubbing in the sanitizer. I tell them to say, 'I am cleaning my hands for your protection.' They see you do it, they hear you talking about it—hopefully they mark 'always' on the survey."
It Pays To Care
"Always" means money in the bank for healthcare providers. “Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said HHS Secretary Kathleen Sebelius, when HCAHPS was rolled out in April 2011. “Under this initiative, Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”
Quality of care translates to patient satisfaction and patient satisfaction means payment satisfaction for the hospitals. Quality of care is heavily weighted towards nursing care and that may lead to improvements in the nursing work environment and nurse-to-patient ratios. Studies have linked patient satisfaction with nurse-staffing levels, higher proportions of registered nurses (RNs), skill-mix, nurses’ work environment, and RN-physician collaboration.
Many hospitals jumped on the bandwagon early and started addressing patient satisfaction through their own surveys. They then used the results to start looking at their own systems. For example, Memorial Hospital and Health System in South Bend, Indiana, refined its approach to patient-centered care based on feedback from a research project by one of their own nurses that questioned patients about their fears of being in the hospital. In response the hospital has instituted some of the following practices:
These may not be the measures every hospital chooses to take but the reality in a pay-for-performance universe is that we are all going to be expected to perform at our best all the time. I think for most of us in healthcare this isn't really an issue. We go to work as nurses with the intent of doing our best for every patient, no matter what area we work in. What the results of these surveys show and how the reimbursement affects our employers is yet to be seen. I think at worst we may be forced to look at our bedside manner and professionalism and we may even get some workplace improvements. I guess we'll find out soon enough.