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Old 06-26-2011, 09:09 AM
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Default Medicare To Begin Basing Hospital Payments On Patient-Satisfaction Scores

Thought your hospital room was dirty? Did your nurse sometimes ignore you? If so, the hospital has a new reason to worry: Patient gripes soon will affect how much hospitals get paid by Medicare.

The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year?s health care law. Consumer advocates say tying patient opinions to payments will result in better care. But many hospital officials are wary, arguing the scores don?t necessarily reflect the quality of the care and are influenced by factors beyond their control.

Medicare has been publishing patient-satisfaction scores on its Hospital Compare website since 2008, but hasn?t used them to adjust payments. Under CMS?s ?value-based purchasing? proposal, Medicare will begin withholding 1 percent of its payments to hospitals starting in October 2012. That money ? $850 million in the first year ? will go into a pool to be doled out as bonuses to hospitals that score above average on several measures.

CMS says more than 3,000 hospitals will be affected. Under the proposal, patient scores would determine 30 percent of the bonuses, while clinical measures for basic quality care would set the rest. Hospitals argue the scores should have less weight, but nevertheless are trying to figure out how to improve their rankings.

?We?re not where we ought to be,? says Dennis Hansen, Shady Grove?s president. To improve satisfaction, nurses now check in with patients every hour. Academic medical centers often fall short of perfection because their patients need multiple medications and see lots of specialists, leaving more room for oversights. to please, whether it?s in a hotel or a restaurant or a hospital. For somebody to really rave about something is an anomaly.?

While many hospitals have been uneasy with the surveys, they?re stepping up the scrutiny about their validity. Dr. James Merlino, chief experience officer of the Cleveland Clinic, which scores below average on seven of nine key patient-satisfaction questions, says doctors and nurses have done their own studies and concluded that very sick and depressed patients give skewed views. For instance, severely ill patients are less likely to report that nurses check in on them every hour?even when logs prove they did, he says.

?Focusing on patient satisfaction is the right thing to do, but it?s also necessary we pick the right metrics and we hold hospitals accountable for things within their control,? Merlino says. ?I don?t think we should hold hospitals accountable for patient perceptions.?

But low patient ratings often spring from real shortcomings, says Jodie Cunningham, director of public reporting at Press Ganey, an Indiana-based company that administers the surveys for more than half the nation?s hospitals. She says poor ratings can be caused by bad employee morale or bed shortages that force patients to remain in emergency rooms for hours before being admitted.

?If your nurses are not getting along with the physicians, it definitely shows in lower scores,? says Cunningham.
Consumer advocates, who want CMS to give even greater weight to the patient views, say the payment changes, even if imperfect, will spur improvement.

http://www.linkedin.com/news?actionB...-tod-b-ttle-14
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Old 06-26-2011, 09:20 AM
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Let me see if I've got this straight.

My hospital gets nearly bupkus from Medicaid now. The patients with Medicaid still get the same care, treatments, meds, tests, procedures, surgeries. They still use the same linens and eat the same foods/snacks, but our hospital gets paid far less for them than for private pay insurance patients.

Medicaid patients come into the ER and never pay a copay, never need to be responsible for any of their bills, and therefore do not hesitate to come in for treatments that cost the hospital $500 (but could have cost nothing if they'd taken care of the problem themselves), They will now be able to say "I didn't like the way she handed my free dinner to me" and have it cost us further?

And under this new proposal, the same patients who already pay NOTHING out of pocket (and often, frankly, are the worst offenders of the overused callbell and complaints to administration) will now be able to lower our reimbursement even further. The very same people who already suck our facility dry in non-payable and barely-payable services rendered will now be able to check a box and make sure we get even less?

I see the death of even more medical facilities in the future.
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Old 06-26-2011, 09:32 AM
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But low patient ratings often spring from real shortcomings, says Jodie Cunningham, director of public reporting at Press Ganey, an Indiana-based company that administers the surveys for more than half the nation?s hospitals. She says poor ratings can be caused by bad employee morale or bed shortages that force patients to remain in emergency rooms for hours before being admitted.

I loved this part best. My facility merged with another a couple of years ago (in an effort to avoid one of the hospitals closing, primarily because of poor reimbursements). So our ER is typically overburdened, as it is the only one in the community, and the only one in the reasonable vicinity to get to. Which means that there is almost always a wait for a bed, people get to be "holds" down there for hours or even days after an MD says to admit them.

And the poor nurses who are struggling to keep these 'hold' patients comfortable when they should be on a floor instead of the ER, the poor nurses who get too many patients dumped on them because "THERE'S A BED!!", well, too bad.

By the time that patient makes his or her complaint (and of course they will), it's going to be the put-upon nurse they make sure to name. Not the administration whose poor decisions put all of us in this situation in the first place. Oh, no, they won't be complaining about THEM. It'll be the front line caregivers who get nailed.

And when funds get cut, so do nursing hours....compounding the situation even more.
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Old 06-26-2011, 12:59 PM
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I could not agree with MDP any more and well said!
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Old 06-26-2011, 01:06 PM
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I could not agree with MDP any more and well said!
Ditto here too. Well said MDP. I think the worst thing that has happened to patient care was Press Ganey. We had far better patient satisfaction when nurses did nursing nad when we had better staffing.
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Old 06-26-2011, 05:54 PM
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It is all part of the Valued Based Purchasing plan, it combines clinical outcomes with press ganey ( and press ganey is only one provider).

The time to complain is before it becomes policy, It is up to all to monitor CMS and give our opinions as they are pushed into action.
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Old 06-27-2011, 09:33 AM
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Think how much money Press Gainey is making off of all of this. What with their publications, nurse prep classes, etc., it must be alot. It seems to me that patients and hospitals should be more concerned with pt outcomes, and not just pt satisfaction. I would rather come home from the hospital infection free, than to have fresh water on my flowers every day.
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Old 06-27-2011, 11:33 AM
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Think how much money Press Gainey is making off of all of this. What with their publications, nurse prep classes, etc., it must be alot. It seems to me that patients and hospitals should be more concerned with pt outcomes, and not just pt satisfaction. I would rather come home from the hospital infection free, than to have fresh water on my flowers every day.

How true Wound Warrier!
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