Holding Nurses Accountable for Patient Satisfaction

The impact of nursing care on patient satisfaction, and even on patient outcomes, has long been established. It just hasn’t been linked to financial incentives – until now, that is. You’ve probably already heard of this expansive initiative with a long name: the Hospital Consumer Assessment of Healthcare Providers and Systems, abbreviated as HCAHPS and often pronounced as “H-Caps.” If you’re still unsure exactly how HCAHPS will affect you and the entire nursing profession, here is some food for thought.

How does HCAHPS work?

HCAHPS is part of Medicare’s new value-based purchasing program, which is an effort to shift to reimbursement models that pay for high-quality care, rather than a high quantity of care. HCAHPS itself is a survey instrument that aims to measure patient satisfaction with the entire hospital experience. Recently discharged patients are asked to answer 27 questions, in seven key topic areas that include responsiveness of hospital staff, nursing communication skills, physician communication skills, pain management, quietness and cleanliness, explanations about medications, and discharge instructions. (You can view the actual survey questions online.)

The survey is designed to allow objective and meaningful comparisons between hospitals, in areas that are important to consumers. Results are published online, and the public can view them at www.hospitalcompare.hhs.gov. But perhaps most significantly, the data will be used to determine reimbursement – and hospitals can gain or lose up to two percent of their Medicare reimbursement fees, depending on how well they score. (A hospital that chooses not to participate in HCAHPS is automatically docked two percent.)

HCAHPS survey data is already being collected and tallied, and the Centers for Medicare and Medicaid Services (CMS) will begin implementing value-based incentive payments for hospitals in 2013.

HCAHPS and nurses: the pros and cons

Nurses make up the largest group of health care workers, and they are the “face” of the daily care that patients receive. So it’s no surprise that the HCAHPS survey section on nurses’ communication has been found to have the greatest impact on overall patient satisfaction and likelihood to recommend the hospital to family and friends.

But some nurses are uneasy about being held accountable for overall patient satisfaction, as we noticed from comments being made on online nursing discussion forums. The most oft-cited concern had to do with the way patient responses are weighted for reimbursement purposes. The survey asks questions like how often nurses communicate well or respond quickly to a patient request, and patients can respond with Always, Usually, Sometimes, or Never – but hospitals only receive credit for the “Always” responses. As health care providers, we know that this all-or-nothing approach can be troublesome. Even when we’re providing very high quality care, there’s sometimes a situation that keeps us from answering a patient’s call light as quickly as we may have liked to.

Still, we can view the HCAHPS initiative as a positive and unexpected opportunity to advance nursing interests. For example, studies have shown that patient satisfaction is higher when nurses have a better work environment, greater collaboration with physicians, and more favorable staffing ratios. Hospitals haven’t always taken note of this data, but now they may have to – and nurses are poised to benefit when they do.

An article titled “HCAHPS: Nursing’s Moment in the Sun” from Nurse Leader magazine also takes an optimistic outlook regarding HCAHPS. Here’s an excerpt:

We are shifting to a different world order. We now have an opportunity to make a real difference because CMS and other payers are looking to nursing for solutions, and noticing and measuring nursing’s contributions to patient outcomes.

Maybe the stars are finally lining up for nursing to be seen as a revenue-producing department: nursing will be measured on its contribution to the solvency of the nation’s hospitals. We have the opportunity to demonstrate that what we do indeed makes a difference.

How you can make a difference

Every patient interaction you’re involved with now has the ability to affect hospital revenue. Take a look at the actual HCAHPS questionnaire and become familiar with the topics patients will be asked about. Be aware that it’s the patients’ perception of care that will matter – and that you can sometimes influence their perception in positive ways, through your dialogue. For example, since patients will be surveyed about how often you provided information about the medication you administered, you might say something like, “This is a new medicine for you, so I want to explain to you in detail how it works and what it is being prescribed for, and then to listen to any concerns you might have.”

When your hospital HCAHPS scores are released, take a look at the data and compare it to other hospitals in your area, as well as to national averages. If you have specific ideas for changes that might improve the patient experience, be sure to discuss them with your nursing supervisor. If this is truly nursing’s moment in the sun, let’s be sure that we shine!

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