In a classmate's assignment titled, "Curious Consumers Start to See More Hospital Data," she writes about the new proposed law linking government payments to hospitals in conjunction with patient satisfaction scores. Under this new proposal, the Center for Medicare and Medicaid (CMS) will begin to withhold reimbursement payments to hospitals based on unfavorable scores patients give regarding their hospital stay. I found this article to be interesting because I work in the health field and I see the results of these new measures already taking effect. While I do agree with one of the points she made, I disagree with others.
I have worked in the health care industry for about 9 years both in a publicly funded and privately run hospital with constant patient interaction. If you have never worked in a hospital setting where you are directly responsible for taking care of people, it's hard to explain or imagine what a care provider has to go through each day. It's one thing to hear about it coming from a family member who is a nurse or a doctor than it is to actually experience it day by day.
Under the new proposal, 1 percent of the reimbursed payments made by the CMS, about 850 million in the first year, will go into a pool to be doled out as bonuses to hospitals that receive an above average score that is based on several measures. Who do you think that money is going to go to? Most likely, hospitals that can afford luxury amenities and whose level of care is different compared to a public hospital like University Medical Center at Brackenridge (UMCB) here in Austin. The author states that UMCB has more obstacles than a private hospital which would probably lower their score. And she would be right. Private hospitals which generate money can afford to look like a hotel and treat their patients like guests to make their stay more comfortable. A public hospital like UMCB doesn't generate the same funds as a private hospital does because they are mostly responsible for taking care of the uninsured which include the homeless and undocumented. Any number of reasons could be used to score a hospital low. For example, telling a patient "no" can anger them even though it might be for their own good. Nurse to patient ratio is not established in Texas which means a nurse could get up to 6 or 8 patients, all of them needing him/her at once. It's a no win situation when one patient is left behind for another. Do they have to show preference for a more vocal patient so that the hospital can receive a higher score instead of those who are in need of greater care? It's a Catch 22.
A point that my classmate makes is a point that I can agree with, but with some reservations. She states that the government should make critical information regarding a hospital's history of complications more available to the public. Reports on deaths, infections and complications would be informative and would enable the public to make a more informed choice as to which hospital they chose to go to. I agree, but I think it should be done more accurately. For example, if a major trauma or complicated infection was transferred from one hospital to another and the end resulted in a death, the original hospital should be the one held responsible. As of now, it falls on the shoulders of the receiving hospital, which in turn would lower their score. In another example, a patient is discharged with specific instructions but has to be readmitted because they failed to comply with the orders given (which happens a lot). That needs to be taken into consideration as well and not be held against the hospital. At other times, a patient's health improves and they are transferred to another facility to continue their care. Unfortunately, sometimes the proper care is not administered and they end up having to be sent back. Situations like that would be held against the hospital. I do not believe that grading the hospital in that manner is fair.
The author also states that hospital staff need to follow guidelines to avoid further infections and complications. Believe me, we do! Now, try telling that to the patient. Infection does spread easily in a hospital but when a patient who is in isolation insists on leaving their room to go outside, what are we supposed to do? Especially if we are afraid of receiving a low score.
Although my classmate makes a good argument regarding more information being available to the public, I believe it has to be done correctly and fairly. I don't agree with her take on patient satisfaction and hospital reimbursements. I think it would tie the hands of health care providers by making patient care all about the dollar sign instead of doing what is best for them. Hospitals should be held accountable for what they can control not by what they cannot. A person's perception of a situation should not hold a whole hospital responsible for trying to do their best.
http://www.kevinmd.com/blog/2012/02/patient-satisfaction-kill.html
http://www.nytimes.com/2012/03/15/opinion/hospitals-must-first-hurt-to-heal.html?_r=1
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