Academic journal article Creative Nursing

Using Patient Satisfaction as a Basis for Reimbursement: Political, Financial, and Philosophical Implications

Academic journal article Creative Nursing

Using Patient Satisfaction as a Basis for Reimbursement: Political, Financial, and Philosophical Implications

Article excerpt

Patient satisfaction has always been important; however, basing monetary value on patients' perceptions is causing a strenuous debate in health care. Hospital administrators and providers alike are scrambling to implement measures to improve patients' experiences of care and avoid cuts in revenue.

On October 1, 2012, Medicare will begin to tie inpatient Medicare reimbursement to patient satisfaction through the Hospital Value-Based Purchasing Program. Although the Patient Protection and Affordable Care Act became a law on March 23, 2010, numerous provisions were slated for implementation at a later date. Many of the provisions offer payment incentives to improve quality of care, and the Hospital Value-Based Purchasing Program is one such provision (Elmendorf, n.d.). For the first time, more than 3,500 hospitals nationwide will be reimbursed for inpatient services provided to Medicare patients centered on quality, not simply quantity, of services provided (U.S. Department of Health and Human Services [USDHHS], 2011a, 2011b).

In fiscal year (FY) 2013, the Centers for Medicare and Medicaid Services (CMS) will reduce base diagnosis-related group (DRG) payments to hospitals by 1%, then increase by 0.25% each year to a maximum of 2% in FY 2017 (Matos, 2011). The money saved from the reduction in payments will be set aside into a pool from which value-based incentive payments or bonuses will be paid to hospitals based on how well they score on 17 clinical quality measures and eight dimensions of patients' experiences of care (USDHHS, 2011c). Although 70% of the bonus is tied to the evidence-based clinical quality measures such as treatment for myocardial infarction, heart failure, pneumonia, and surgical care improvement, the remaining 30% is tied to patients' experiences of care (USDHHS, 2011b). With experiences of care based solely on patients' perceptions, many in health care are questioning the rationale for allowing subjective data to influence reimbursement (Daly, 2011).

Patients' experiences of care are determined using core elements of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, including

* how well nurses communicated with patients,

* how well doctors communicated with patients,

* how responsive hospital staffwere to patients' needs,

* how well caregivers managed patients' pain,

* how well caregivers explained patients' medications to them,

* how clean and quiet the hospital was,

* how well the caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions), and

* overall rating of the hospital (McKinney, 2011; USDHHS, 2011c).

Although the measures have been espoused by national bodies of experts such as the National Quality Forum, many other groups have opposed them (USDHHS, 2011b). Hospital groups aggressively but unsuccessfully pressed federal officials to decrease the amount of the bonus tied to patient satisfaction, stating that 30% was excessive when based merely on opinions rather than facts. "Some hospital advocates and researchers have warned that the survey has undergone little peer-reviewed validation and does not account for apparent patient biases" (Daly, 2011, p. 30).

Although the current HCAHPS patient-mix adjustment includes education level, self-educated health, non-English primary language, age, and service line, it does not include all the items that have a potential impact on scores, leaving many hospitals at a disadvantage from the start (HCAHPS, 2011; Selvam, 2011). The Association of American Medical Colleges (AAMC) cited research showing that the HCAHPS survey tool does not adjust risk fairly, producing inequitable results for both urban and teaching hospitals that treat disadvantaged patient populations such as those with a lower socioeconomic status, higher severity of illness, and longer lengths of stay (AAMC, 2012). …

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