South Florida Hospital News
Tuesday October 24, 2017
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May 2013 - Volume 9 - Issue 11

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Welcome to the World of Transparency

Healthcare reform continues to accelerate. Changes have taken place impacting how we do business and how the public views us. Outcomes are transparent and compared for all to see. From a quality perspective, this is a good thing. Why shouldn’t the public know how we care for patients so they can look for value? But the big game changer is that we now get paid based on these outcomes.
 
Reimbursement for hospital-acquired conditions changed years ago and rightfully so. Why should we get paid more if a patient developed an infection, a pressure ulcer or was injured in a fall? Clearly the system was broken, as many are preventable events. Value-based purchasing raised the stakes as quality and patient satisfaction metrics are compared to peers and impact reimbursement.
 
Who influences these outcomes more than nurses? No one. We own most of it. Whether we like it or not, healthcare is a service industry and the service we provide is patient care. Now more than ever, nurses are influencing reimbursement and this is an opportune time to better quantify the dollar impact nursing care can have on the bottom line, good or bad. Nurse leaders need to be able to articulate to finance leaders the rationale for resources to achieve the best reimbursement.
 
While the system of measurement is not perfect, it is what we have. We must understand the methodologies and work with it. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys are here to stay and will likely expand. One can argue that comparing patients from inner city settings where less educated/lower literacy rate populations reside shouldn’t be compared to rural-America hospitals where everyone knows everyone. Quality metrics could have the same arguments that higher risk/tertiary facilities have sicker/less compliant patients. Again, it’s what we have for now.
 
So what is the answer? We compete. Process improvement isn’t a new concept to healthcare, but we often are challenged with sustaining the gains. Regarding patient satisfaction, the nursing domain questions most greatly influence patients, so our nurses must know expectations and be held accountable for ensuring consistency. Hourly rounding and focusing on key patient needs has solid evidence behind it in improving patient satisfaction scores addressing pain, reducing call lights, falls and pressure ulcers. These are basic things, yet we often struggle consistently doing them. This is a leadership issue about accountability if we don’t get it right. Discharge phone calls are another proven method to ensure patients have a clear understanding of their discharge plan. It also provides an opportunity for clarification and service recovery prior to patients receiving their surveys.
 
Patients expect quality when they come into the hospital setting. It’s non-negotiable in their eyes - as it should be. As we make improvements in care, the bandwidth to differentiate performance narrows drastically, so we can expect new indicators to be added in areas where performance is not where it needs to be and, again, linked to reimbursement. As hospitals continue to see decreasing reimbursements, we must provide the most efficient, safe and satisfying experience for our patients. What this means is that we compete on quality and service.
 
Nursing has, for the most part, embraced this and is leading the way in quality and the patient experience. Outcomes are improving, but the baseline continues to rise. If you aren’t improving, you are falling behind. We must view this as our time to prove the value of our profession, stay focused and drive change. Our patients will be better off and we will improve the healthcare system through reduced cost and improved outcomes.
 
 
Steven Seeley, Vice President, Patient Care Services and Chief Nursing Officer, Jupiter Medical Center, can be reached at Steven.Seeley@jupitermed.com.
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