Hospital Medicare Payments tied to Quality and Patient Satisfaction

Medicare has two payment incentive programs for hospitals. Value Based Purchasing gives bonuses and penalties to hospitals based on clinical process factors (45% weight), patient experience/satisfaction (30% weight), and outcomes (25%).  Another program penalizes hospitals when the number of patients readmitted within a month are excessive. Both programs are in their second year. Hospitals could gain up to 1.25 percent in payments or lose as much as 3.25 percent from the two programs combined.

To assess patient care and satisfaction, a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is used.  The survey is administered to a sample of adult patients between 48 hours and six weeks after discharge.  All short-term, acute care, and non-specialty hospitals are invited to participate in the HCAHPS Survey. Over 4,000 hospitals participate in HCAHPS. The goal is to get at least 300 completed patient surveys from each hospital each year.

Patient Experience encompasses eight important aspects of hospital quality:

1. Communication with Nurses
2. Communication with Doctors
3. Responsiveness of Hospital Staff
4. Pain Management
5. Cleanliness and Quietness of Hospital Environment
6. Communication about Medicines
7. Discharge Information
8. Overall Rating of Hospital

The first four questions of the survey target care given to the patient by the nurses. The questions address courtesy/respect given to the patient, nurse listening skills, nurse explanations, and nurse responsiveness. For maximum scores, nurses should keep these factors in mind and practice so their communications and actions are aligned with a positive patient experience.  With focus and practice, positive nurse behavior becomes second nature. Hospitals want and need staff members that provide excellent Customer Service at all times. Their reputation and the level of reimbursements from Medicare are tied to patient satisfaction. Keep all these factors in mind so we continue to be  rated highly on a consistent basis by the hospitals and patients we serve.  We want to be known for doing things the 24 Hour Way, which reflects all key points in this article.

Sources for article above:

(1) Rau, Jordan. “KHN: Kaiser Health News.” Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality. N.p., 14 Nov. 2013. Web. 21 July 2014 . (2) “Survey of Patients’ Experiences.” Hospital Patients’ Survey Data. Medicare, n.d. Web 21 July 2014.

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