Hospital Performance Surveys: HCAHPS

2014-05-02_16-08-36If you have been admitted to the hospital in the last few years, you may have received a phone call after you were discharged asking you questions about your recent hospital stay. Some questions that may have been asked include if your nurses and/or doctors ALWAYS communicated well with you, if you ALWAYS received help as soon ask it was asked for, if your pain was ALWAYS controlled, if staff ALWAYS communicated well about medications before they were given, if your room and/or bathroom was ALWAYS clean, and if your environment was ALWAYS quiet.


These questions are part of a survey called “Hospital Consumer Assessment of Healthcare Providers and Systems.” At first glance, this seems like a great idea, right? A rating system for your healthcare team so that they have an idea of either how well they are doing, or what areas they can improve upon, not so much. Just like with anything else, there are hidden terms and conditions, things you as the consumer may or may not know about these surveys.

A company called Press Ganey, whose sole focus is improving patient satisfaction, conducts these surveys for a governmental agency called the Centers for Medicare and Medicaid Services (CMS). These patient satisfaction surveys determine in part if the hospital will get paid for the services they have already provided. They also allow patients to see how well hospitals in their area compare with each other and hospitals across the nation.

These all sound like noble goals, but here’s the thing. These surveys allow CMS to retain a portion of the money they allot for specific procedures rather than pay the full amount to the hospital system giving care to that patient. When these surveys are done, only those hospitals who score perfectly across the board are paid the portion that was initially withheld. Many times, this is the only payment that hospital is going to receive from those patients.


The stated goal of these surveys is to improve safety as well as patient satisfaction. Here’s the drawback in all of that: we are making it a performance-based system. We are depending on people saying yes, they were ALWAYS satisfied with everything that went on during their admission. If patients aren’t ALWAYS satisfied, that negatively impacts the care hospitals can provide in a very direct way. No one I know, myself included, answers a survey and says ALWAYS across the board. That’s just part of our culture. And there are always ways in which one can improve. No one is perfect, including healthcare providers.

I work for a large metropolitan healthcare system in Nashville. We have begun a campaign to improve our patient satisfaction scores so that we can continue to provide very important services to patients and families across the Tennessee Valley. Last year, we had to make some hefty budget cuts that eliminated a lot of staffing positions. When I was initially hired for the position on the busy medical unit where I currently work, nurse to patient ratios were 1:4 with 3 Certified Nursing Assistants (CNAs). Shortly after I arrived, the budget cuts occurred. Our ratios changed overnight to 1:5 with 2 CNAs. You would be surprised at the difference adding only one complex patient to an already difficult patient assignment can make, especially when you cut CNAs. Where before nurses were responsible for 4 patients who all had CNAs, we are now responsible for 5 patients, and only 3 having CNAs to assist us.

Part of the reasoning behind these budget cuts was related to patient satisfaction and our reimbursement due to those scores. What this type of performance-based payment for hospitals does is eliminate jobs and sometimes cut out the smaller hospitals in competition with larger systems.

What does this mean for our communities in and around Limestone County? Should Athens-Limestone Hospital, Decatur General, and Madison Hospital not “measure up” in comparison to other larger systems and be unable to compete with them, they are in danger of closing their doors or becoming part of larger systems that will monopolize the healthcare system. There must be some type of accountability for hospitals and healthcare providers, however tying funding to questions that are solely based on patient’s perception of happiness and satisfaction is not the answer. It puts unrealistic demands on an already taxed system that needs relief, not more regulation.
By: Rachel Clark, RN, BSN