Reports have shown that ambulatory primary care practices that include patients and families in their quality improvement efforts have many benefits including better relationships and interactions ...with patients. In this paper, we describe our experience of involving our patients, family, and staff who are members of or Patient and Family Advisory Council (PFAC) in our quality improvement efforts related to patient experience. For a year, members of the PFAC suggested creative implementations to our office policies and workflow to improve satisfaction scores on the Clinician and Group Consumer Assessment of Health care Providers and Systems survey in key areas: information about delays, wait times in clinic, and convenience of appointments.
Medicare hospital Value-based purchasing (VBP) program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are ...associated with a hospital's VBP score, and consequently incentive payments.The objective of the study was to assess the association of hospital characteristics with (i) the mean VBP score, and (ii) specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC) score and patient satisfaction score.
Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS) regression and quantile regression (QR), respectively.
VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit), smaller bed size (vs. 100-199 beds), East South Central region (vs. New England region) and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients) were positively associated with mean VBP scores (p<0.01 in all). Total number of CPC measures reported, bed size of 400-499 (vs. 100-199 beds), a few geographic regions (Mid-Atlantic, West North Central, Mountain and Pacific) compared to the New England region were negatively associated with mean VBP score (p<0.01 in all). Disproportionate share index, proportion of Medicare and Medicaid days to total inpatient days had significant (p<0.01) but small effects. QR results indicate evidence of differential effects of some of the hospital characteristics across low-, medium- and high-quality providers.
Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.
The Hospital Consumer Assessment Health Providers and Systems survey on patient satisfaction has taken on greater significance with the introduction of the Hospital Value Based Purchase program by ...the Center for Medicare and Medicaid Services. Content analysis of open-ended comments by patients has seen limited use in spite of the insight in can provide into factors contributing to patient (dis)satisfaction. This article uses an emergency department setting to gain insight from patient experience.
Health care reimbursements are changing from a medical care-based scale to a pay-for-performance system. The Value-Based Purchasing Program uses clinical quality indicators along with the Hospital ...Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey as part of an incentive program for hospitals to gain reimbursements based on the patient care experience. Although clinical quality indicators are often outside of a sonographer’s scope of practice, several of the HCAHPS items are a routine part of a sonographer’s daily duties, such as communication and responsiveness to the patient and cleanliness of the facility. Providing education concerning HCAHPS and Value-Based Purchasing to clinical sonographers, as well as student sonographers, will improve patient interactions and assist hospitals in gaining reimbursements.
Abstract Background Low-income, publicly insured admissions historically cost more to treat than does the average patient. To ensure that hospitals are reimbursed an adequate amount for care of ...indigent populations, Medicare reimburses hospitals an additional percentage amount according to federally set financial schedule. At 15% of a disproportionate patient percentage, a hospital is reimbursed an extra 2.5% of the standard prospective payment rate. Objective This research seeks to determine whether hospital qualification as a Medicare Disproportionate Share Hospital results in higher patient experience ratings. Methods A regression discontinuity method was used to determine the effect of lagged Disproportionate Share Hospital (DSH) status on next year patient experience ratings. The Hospital Consumer Assessment of Healthcare Providers and Systems data provide publicly available patient ratings. Results On average, hospital ratings increase by 6% as a result of DSH status. Hospital ratings increase by an average of 6.5% when nonprofit hospitals are analyzed. This finding is primarily driven by patient facility cleanliness and medical provider communication ratings. Conclusions The federal mandate that individuals purchase health insurance in the United States coupled with the state expansion of Medicaid coverage will theoretically eliminate the need for Medicare DSH payments. It is calculated, however, that hospitals will need increased Medicaid reimbursements of more than $300 per patient to make up for the loss of Medicare DSH reimbursements. Hospitals will likely suffer financially as a direct result of reduced Medicare reimbursements through the DSH program.
Aim
This article describes the Clinical Nurse Leader role in implementing person‐centred care bundles to improve patient outcomes through an innovative culture of caring.
Background
Demonstrating the ...financial value of introducing the Clinical Nurse Leader role into an organisation is essential for sustainability. Previous authors have established the Clinical Nurse Leaders' influence on patient satisfaction and have suggested that Clinical Nurse Leaders improve the continuity of care after discharge.
Evaluation
Descriptive data are shared to illustrate the effectiveness of implementing the patient care bundles and a Clinical Nurse Leader‐driven discharge phone call process.
Key issues
Clinical Nurse Leaders who practise from a caring lens are uniquely situated to lead initiatives that drive person‐centred care with the goal of reducing readmission rates. Patients who receive person‐centred care have an improved perception of the hospital experience and are more likely to return to the facility.
Conclusions
Clinical Nurse Leaders establish relationships with patients that increase the likelihood of successful outcomes from the discharge phone call process. Further evaluation of the Clinical Nurse Leader's role and potential impact on patient outcomes is warranted.
Implications for nursing management
Clinical Nurse Leaders are uniquely prepared to lead transformational change within an organisation. Clinical Nurse Leader interventions that are developed at the microsystem level in response to problems may have system‐wide implications.
Providing profitable online content has been an elusive goal, challenging many companies such as the New York Times, Disney/ABC/ESPN, and Microsoft/Slate. Charging for content has been hit-or-miss, ...attributable to a lack of generally applicable models of information value. Previous studies in the management information systems literature emphasized extrinsically motivated content (addressing tangible gains), while many sites target intrinsic goals such as entertainment or education. This study examines potential factors influencing willingness to pay for intrinsically motivated online content. Data from 392 college students indicate that even when analyzing content whose potential rewards are intangible and nonquantifiable, potential consumers focus on "expected benefits" as the main antecedent for willingness to pay. Other antecedents, such as perceived quality and provider reputation, only affected willingness to pay indirectly through expected benefits. Researchers are offered a baseline model for future study, and practitioners are advised to provide initial visitors a clear message about benefits of use to entice them to pay for content.
Background: The Centers for Medicare & Medicaid Services pays for services provided through traditional fee-for-service (FFS) Medicare and managed care plans (Medicare Advantage MA). It is important ...to understand how financing and organizational arrangements relate to quality of care. Objectives To compare care experiences and preventive services receipt in traditional Medicare and MA for healthy and sick beneficiaries. Methods: Randomly selected beneficiaries responded to the 2003 and 2004 Consumer Assessments of Healthcare Providers and Systems (CAHPS®) surveys. We analyzed 237,221 MA responses (80% response rate) and 153,535 from FFS (68% response rate). We compared case-mix-adjusted CAHPS scores between FFS and MA for healthy and sick beneficiaries on 7 CAHPS measures of care experiences and 3 preventive service measures. Results: CAHPS scores were lower in MA than FFS for all care experience measures except office wait time. The sick had less favorable care experiences than the healthy for all measures, but were more likely to receive each preventive service (P < 0.001). FFS-MA differences were larger for the sick than the healthy for 5 of 7 experience measures (P < 0.05), and were twice as large for physician ratings and interactions. Office wait time and rates of immunization were better in MA than FFS (P < 0.001), with no differences between healthy and sick groups. Conclusions: Beneficiaries in health plans report less favorable care experiences than those in FFS, particularly among the sick, but preventive service measures are higher in MA. The Centers for Medicare and Medicaid Services should strengthen efforts to improve care experiences of the sick, particularly in MA, and preventive service receipt in FFS.
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