Wednesday, November 09, 2011

scathingly brilliant medicare idea #1,678

Health care just keeps getting weirder and weirder.

Beginning in October 2012 Medicare will begin withholding 1% of its payments to hospitals to put into a fund that will amount to $850 million dollars in the first year. Based on patient satisfaction scores, this money will be doled out in bonuses to hospitals with the highest scores. The idea behind this being patients will get better care.

This obsession with patient satisfaction is already going on in a lot of places, some more than others. There is nothing wrong with wanting patients to be happy. A worthy goal.

What makes a patient happy? Feeling like somebody cares, relieving their pain, understanding what is going on, getting better.

Nurses care, otherwise we wouldn't be nurses. We want to spend time with patients, listen to them, support them. Here's the problem: We don't have time. We are short staffed. We are required to chart a thousand things on the computer. Call light not answered in a timely manner because there aren't enough nurses, because they are trying to complete all the charting requirements = unhappy patients = bad satisfaction scores = less money for hospitals.

Nurses relieve pain. We want to relieve pain. However, there are a lot of drug seekers in the world. Sometimes they don't get what they want. They get mad. Mad drug seeker patient = low satisfaction score = less money for hospitals.

Nurses want the patients to understand what is going on. They want to be able to take the whirlwind of doctors, results, etc. and break it down in a language the patient can understand. Sometimes we can't do that: short staffed, busy charting. Confused patients = low satisfaction scores = less money for hospitals.

Patients want to get better. Of course they do. Nurses want them to get better too. Sometimes nurses are too busy or somebody deteriorates, there is short staffing and all the tasks that patients require to get better can't be accomplished. Patient having to stay longer or develops complications because nurse not able to give required care = low satisfaction scores = less money for hospitals.

Better patient satisfaction and improved care, great goals to have. Will there be improved nurse staffing to make that happen: NO. Are they realistic in todays health care system: NO.


Óli said...

Maybe this is not a task for nurses, maybe it's a task for administrators to lower burden on nurses. If charting was kept to a minimum you'd have more time with the patients. This is not an individual effort.

Anonymous said...

The problem is that administrators don't want to lower the burden on nurses, if anything, they raise the burden by laying off people in these times while at the same time expecting them to make all '5' 's on the satisfaction scores.

Then there are the drug seekers. They get surveys too, if you don't feed their habit, guess what scores they're going to give you? Some hospitals and physicians have actively encouraged nurses just to give it to them to make them happy. What about the histrionics, hypochondriacs, and psychiatric patients who just can't be satisfied unless you are the second coming of Jesus Christ?

While I can appreciate the idea of patient satisfaction, there comes a time when expecting absolute perfection in patient satisfaction, for every patient, regardless of the circumstances becomes absurd.

Stay the Balm said...

I couldn't have said it better myself! I had an alcoholic patient I was watching for lunch coverage who demanded a bath three times in ten minutes...I am sorry the intubated guy next to you with the low blood pressure is my priority and my nursing assistant has 12 other patients and 7 nurses, along with phones ringing and rooms to stock. I am so sorry you had to wait 11 minutes for your bath!

hoodnurse said...

We're pretty much screwed when this goes into effect. Super busy hospitals are simply never going to have satisfaction scores as high as the fancy ERs in the 'burbs who say 2-3 patients an hour. People don't like waiting and the nurses can't give them the care they want because they're too busy with the mob of other patients. Decreased reimbursement and funding is most certainly going to give way to decreased staffing and even lower satisfaction scores, until we're doing this shit for free.

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