National Nurses United

CE2_Oct REV 11/6/10 1:38 PM Page 15 care, doctor care, and hospital care. A single item is also included that assesses whether or not the patient would recommend the hospital to family and friends. The seven composites had a median internal consistency reliability of 0.69 and a median hospital-level reliability of 0.74 in the pilot study. In addition, these reporting composites were significantly associated with global ratings of the hospital and willingness of patients to recommend the hospital to family and friends. In May 2005, the final 27-item HCAHPS survey was endorsed by the National Quality Forum (NQF), a national organization that purportedly represents the interests of consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. In December 2005 the federal Office of Budget and Management gave final approval for the national implementation of HCAHPS for public reporting purposes. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) the hcahps is a standardized, publicly reported nationwide survey of patients' perceptions of their hospital experience that was intended to produce data that allows "objective and meaningful" comparisons of hospitals on topics that are important to consumers. The three broad goals of the HCAHPS survey are: to produce data about patients' perspectives of care. to encourage new incentives for hospitals to improve quality of care through public reporting of the results. to enhance accountability in healthcare by increasing transparency, (through public reporting of consumer satisfaction perceptions), of the quality of hospital care provided in return for public investment. Hospitals implement HCAHPS under the auspices of the Hospital Quality Alliance (HQA), a private/public partnership that reportedly includes major hospital and medical associations, measurement and accrediting bodies, government, consumer, and other stakeholders with an interest in improving hospital quality. The survey, its methodology, and the results it produces are in the public domain. The enactment of the Deficit Reduction Act of 2005 created an additional incentive for acute-care hospitals to participate in HCAHPS. Since July 2007, hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions ("subsection (d) hospitals") must collect and submit HCAHPS data in order to receive their full IPPS annual payment update. IPPS hospitals that fail to publicly report the required quality measures, which include the HCAHPS survey, may receive an annual payment update that is reduced by 2.0 percentage points. Non-IPPS hospitals, such as Critical Access Hospitals, may voluntarily participate in HCAHPS. The recently enacted Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) includes HCAHPS among the measures to be used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program, beginning with discharges in October 2012. The HCAHPS survey asks discharged patients about their recent hospital stay. The survey contains 18 core questions about the socalled "critical" aspects of their hospital experiences, (communications with doctors and nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital environment/patient O C TO B E R 2 0 1 0 rooms, pain management, communication about medicines, discharge information, overall rating of the hospital, and would they recommend the hospital to family and friends). The HCAHPS survey is not restricted to Medicare beneficiaries, and is administered to a random sample of adult patients across medical conditions between 48 hours and six weeks after discharge. Hospitals may use an approved survey vendor, or collect their own HCAHPS data (if approved by CMS to do so). To accommodate hospitals' preferences, HCAHPS can be implemented by a choice of survey modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR). If you're happy and you know it, clap your hands? although the stated aim of the HCAHPS is to produce valid and reliable objective data for hospital comparison, many credible researchers are of the opinion that the number of confounding variables poses a substantial threat to the validity of the data. Experienced medical and nursing researchers know that patients' perceptions and the subjective interpretation of their experiences can be limited and of little value as a consistent and reliable indicator of quality, due to several uncontrollable variables such as differing levels of cognitive ability, impairment due to illness, injury, clinical condition, and the side effects of therapeutic interventions and medications that may render their responses useless as empirical evidence and for making meaningful comparisons. And what about the patients who died? It's a small leap to consider the fact that since those "customers" won't be coming back, their satisfaction, or lack thereof, with the care they received, is of little concern to the proprietors of hospitality industry schemes. It stands to reason, because what they're looking for is repeat "business" and customer loyalty based on "satisfaction." The exception of course, would be the "perception" of the family and friends. Professionals understand that loss and grief is a process that can involve many stages, from shock and numbness, shame and doubt, to anger and frustration. If families are not "happy" or "satisfied" with the outcome of their loved one's hospitalization, chances are they might be inclined to go looking for someone to blame; chances are they might even consider filing a lawsuit against the hospital; chances are that a good consumer advocate attorney might lift the lid on the smiles and satisfaction marketing schemes and uncover the fact that the hospital's RN-to-patient ratios were unsafe, and that subtle signs and symptoms of deterioration were missed due to deliberate short-staffing. The point being that as nurses, we're educated, licensed, and experienced to assess whether or not the care we're able to provide is safe, therapeutic, and effective, and whether or not there are barriers to our ability to apply the nursing process for the exclusive benefit of our patients. Patients and their families are generally not qualified or sophisticated enough to make that determination with regard to true "quality" of care indicators, i.e., whether or not there were sufficient numbers of competent RNs employed and on duty to meet their needs and reduce their risks of suffering preventable complications of their illness, injury, or treatment. Ignoring the evidence: Collaboration with industry for profit and control over the past several years, many hospitals have cut costs by reducing their licensed nursing staff in response to declining man- W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 15

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