The Value-based Purchasing Program was mandated in the 2010 Healthcare Reform Law. Medicare’s transition to this program will alter reimbursements to hospitals based on the quality of care provided to patients and patient satisfaction scores. Medicare will cut 1 percent payments to hospitals and set that money aside in a bonus pool. Hospitals performing better than average on a variety of measurements, or improve their scores from the previous year, would earn bonus payments, totaling $850 million in the first year. The bonus pool would increase to 2 percent of Medicare payments in October 2016.
Seventy percent of the bonuses will be based on how often hospitals follow guidelines on 12 clinical care measures. These include giving anti-clotting medication to heart attack patients within 30 minutes of arrival in the hospital; providing antibiotics to surgery patients just before an operation; and taking steps to avoid blood clots in patients who undergo surgery. Thirty percent of the bonus will be determined by how patients rate hospitals on their hospitalization experiences. Medicare will use hospital-conducted surveys that ask patients about how nurses and doctors communicated, how clean their rooms and bathrooms were and how well their pain was controlled, were they given proper discharge instructions, etc.
An analysis provided by Kaiser Health News shows that the unhappiest patients are in the Northeast and California compared to patients in the South and Midwest. The reason why patients in the Northeast are unhappy….they have high expectations, they are less polite, and grumpy, according to analysts. Hospitals are scrambling to provide amenities to patients and get good satisfaction scores to maximize their reimbursement. Patients do not appreciate long waits in the emergency rooms, crowded elevators, and expect prompt attention when they arrive in their doctors’ offices. I personally know a patient who had a fairly good stay in the hospital and was ready to give good satisfaction scores until the day of her discharge when her nursing attendant wasn’t very polite! So, unhappy patients will directly affect hospital reimbursement in the future and hospitals are doing everything they can to boost those scores. Renovations, additions to existing buildings, and new buildings definitely boost patient satisfaction even if the care provided is the same.
Ratings can affect hospitals that cater to high-risk cases. The longer the patient is hospitalized, the lower the satisfaction score the hospital gets, and depressed patients tend to give poor satisfaction scores. Some hospitals have emergency room representatives talking to patients to inform them of their wait period, and others have a fast-track for patients arriving with routine problems like fever, minor injuries, etc. In the children’s wards parents are provided food and snacks so that they can stay with their children (and also in the hope they will give a high satisfaction score on discharge!).