Ashlee Manwaring, Brigham Young University
Nursing
Purpose: To examine how the new policy of Medicare/Medicaid reimbursement being based on HCAHPS scores affects nursing care. Rationale: The Patient Protection and Affordable Care Act (PPACA) mandates that Medicare and Medicaid reimbursement be based on hospital performance and patient satisfaction. Patient satisfaction is measured nationally through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey was development in the early 2000’s to create a uniform measure for patient perspectives regarding their inpatient stay; however, with the HCAHPS scores being related to Medicare and Medicaid reimbursement, hospitals are required to reevaluate their quality of care from the patient, not medical, perspective. Van Empel et al. (2011) found that physicians and nurses primarily value medical outcomes of treatment. While, at the same time, patient’s value patient-centeredness, even if it means decreasing the desired outcome of treatment. Undertaking: A literature review was completed by searching in CINAHL and Medline. Preliminary research used HCAHPS and Medicare reimbursement as key words. Second, a search was completed using HCAHPS and nursing as key words. All results were published between 2008 and 2012. Outcomes: Kutney-Lee et al. (2009) reported that patient satisfaction was primarily linked with nurse-to-patient ratio, interdisciplinary collaboration and work environment. Research by Robinson and Watters (2010) found the main factor in patient dissatisfaction was feeling like the nurses were short staffed, task-oriented and rushed, leaving the patient lacking adequately communication to understand their situation. Van Empel et al. (2011) reported patients’ willingness to change providers and facilities to received patient-centered care. Conclusion: Nurses have the greatest potential to effect patient satisfaction. Therefore, with the new regulation of Medicare and Medicaid reimbursement based on patient satisfaction surveys, nurses have a greater responsibility to ensure patient satisfaction. From the research presented, the main nursing implication is to help each patient feel like their care is centered on what is important to that individual. This can most easily be accomplished by the nurse opening a line of communication with the patient, and then advocating for the patient’s wishes.