Are HCAHPS Scores Too Uncontrollable?

Although the federal value-based purchasing program went into effect at the start of the month, some hospital executives and physicians continue to struggle with the concept of reimbursement tied to patient satisfaction surveys and say such feedback is difficult to control, according to a Wall Street Journal report.

For this fiscal year, Medicare will cut payments to hospitals by 1 percent, or an estimated $963 million. That money will instead be distributed to hospitals with high performance scores, 70 percent of which are based on procedural metrics and 30 percent tied to Hospital Consumer Assessment of Healthcare Providers and Systems scores.  

Hospitals that are older, located in inner cities or tend to admit patients through crowded emergency departments say their scores will take a hit due to factors out of their control. Some physicians and nurses also feel the survey is at odds with the nature of medicine. For instance, the survey question, "How often did the hospital staff do everything they could to help you with your pain?" can conflict with providers' efforts to reduce painkiller abuse.

CMS officials say the measures are largely related to communication, something that should be universal regardless of the hospital facility. CMS' CMO, Patrick Conway, MD, also said the agency may consider whether the question about pain control may need an adjustment.

Rhonda Scott, PhD, RN, CNO at Grady Memorial Hospital in Atlanta suggested things like patient experience and satisfaction are more ambiguous in hospital settings. "You go to Disney for a great vacation experience," Dr. Scott said in the report. "You go to Ruth's Chris for a great dining experience. Do you think it is a great experience when I tell you that you have stage-four cancer and you may be dead in three months?"

Grady's CEO, John M. Haupert, expects the hospital to lose $230,000 in federal payments, largely due to its low patient satisfaction scores. In the hospital's latest score, 57 percent of patients would rate their experience a nine or 10 (on a scale of zero to 10) compared with the national average of 66 percent of patients.

The hospital has taken measures to increase that score: Nurses are required to round patients' rooms every hour, the hospital offers twice as many TV channels in rooms and physicians are required to sit next to patients' beds and converse at eye level.  

More Articles on Hospitals and Patient Satisfaction:

Achieving Key Quality and Patient Safety Measures of the Affordable Care Act
4 Must-Have Traits for Hospital Employees in a Value-Based World
Report: 10 "Very Important" Factors Contributing to Patients' Healthcare Experience

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