I believe nursing can and should be a field that fosters both patient-centered care whilst allowing enough room for CMS and it's value-based purchases regulations. Let's face it, we can not run from VBP, and healthcare is getting more and more regulated by the higher powers. So how can we implement and accept that these changes are part of the evolving field of nursing?
First, let's accept that these mandates are not something management came up with to ruin our work life, and the same way they are on top of the staff to make sure things are working accordingly, the hospital administration department are also harassing them, if not more than they harass us.
But we all agree there needs to be a balance between care quality and care delivery costs. But we feel as implementation of HCAHPS into our healthcare system has limited the quality of care we can deliver, where in fact it's a tool to measure the quality of the care we are delivering, and in my opinion hospitals have misinterpreted the use of it, and how to implement changes. Invest in evidence-based solutions to improve care quality and patient satisfaction, I'll give you a hint; it is not a new flat screen tv. It is adequate staffing levels!!!
Why a VBP model?
The U.S. spends nearly 18% of GDP on healthcare, more than any other country (World Bank, 2014). But, the U.S. patient outcomes are not better than any other developed nations.
Dr. Donald Berwick, Centers for Medicare & Medicaid Services (CMS) Administrator describes it as, “Instead of payment that asks, 'How much did you do?' the Affordable Care Act clearly moves us toward payment that asks, 'How well did you do?' and more importantly, “How well did the patient do?”
So, back to my initial point; this isn't going anywhere for the time being, but how can we properly incorporate the basis of VBP into our daily routine and still provide the actual patient-centered care, and I mean care needed to save their lives, and not the fact that I didnt bring you a cup of coffee the moment you demanded it.
I believe that it is possible to do both, by including the patients in the process, and actually holding them accountable for their own health outcomes. Are we even allowed to do that? ....Why not?
How well I did as a nurse is only a reflection of how well you did as a patient. So, bottom line, your satisfaction with your health and the care I provided is a reflection of how well you responded and your acceptance of my evidence-based practices.
How can you as a patient rate my care if you refuse to accept it? How can you have a positive outcome if you don't follow through our recommendations? CMS should have a guideline to rate the patients as well, if the patient does not follow their providers recommendations, why are we as are givers held accountable?
How can my HCAHPS scores reflect the opinion of a patient that refused to accept a diabetic diet, because he hates diet soda, now all of a sudden I am an incompetent nurse? All I can do is educate, but I can't force a patient to comply.
CMS must hold the people they are providing coverage for accountable for their healthcare decisions. In an attempt to reach the Healthy People 2020 goals, give the patient the power to choose to be healthy, while most times all we can do is advocate and educate.
How do you rate the care you received?
Statistically speaking, people who have complaints or bad experiences are more likely to fill out surveys and write reviews than those with positive experiences. Randomly selecting patients to send surveys to, and hoping they will return them are not the best way to gather up information on the care quality of a hospital and the staff care delivery.
The Dude Nurse
Klaus Campos, BSN-RN