By Chuck Lauer
I was at my local post office the other day where I ran into a neighbor of mine who had recently had surgery. I asked her how she was feeling and if she had gotten her strength back. She said she was feeling much better and was “90% recovered.” As we talked, however, it came out that she had not heard from her surgeon since being discharged.
That was particularly troubling because my neighbor's husband is one of the top executives at the hospital where she had her surgery, a facility with a good reputation for clinical care. I was about ready to say something about the way I was treated at that hospital myself when I had surgery about two years ago, but before I could open my mouth, a woman standing in line in front of us turned around and said she had been treated badly there when she had been admitted a few months ago. This exchange was straight out of a movie scene, but not a movie that the CEO of the hospital would have found very entertaining.
I happen to know this CEO, who is well thought of in the industry, having received many accolades for his stewardship of the hospital. He also has served on a number of councils and committees of leading healthcare organizations. I never told him about the poor treatment I received at his facility. Now I realize I should have spoken up about the noisy hallways, the nurses and physicians barging into my room without announcing their intent, and the confusion that ensued when I asked who was in charge of my care. The hospital had recently gone to a hospitalist model, and I had been there for a number of days without knowing who among the five physicians parading through my room at various times was supervising my care. Even the doctors weren’t sure. I was not a happy camper; the whole experience left a bad taste in my mouth.
I have talked to other patients in other parts of the country, and they tell me similar stories about bad and careless service. It shouldn't be that way because most hospitals try hard to make sure that patients receive quality clinical care. And yet they fail when it comes to treating the whole patient, who has emotional as well as medical needs. Upon discharge, it is not necessarily the fact that their physical condition has improved that sticks with patients, but rather the lack of consideration for their feelings at a time that is almost always a stressful point in their lives. In fact, studies also show that having a negative opinion of their care affects a patient's ability to recover from a procedure and follow through with post-acute care.
Those bad vibes are soon going to translate into lost money for many hospitals, as the federal government’s Hospital Inpatient Value-Based Purchasing Program takes effect next fall. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey counts for 30% of the total score under this incentive program, which allows Medicare to withhold 1% of payment,with the percentage doubling to 2% in 2017, which hospitals will have to earn back. The other 70% of the money at risk is tied to clinical quality indicators. The program is part of the health reform law and is designed to force hospitals to improve the quality of care they provide.
As a result of the program, hospitals are putting physicians, nurses and other employees through customer-service training, as well as hiring patient-experience consultants, creating dedicated departments for customer service and designating staff ombudsmen to deal with complaints. They are also giving employees financial incentives, such as bonuses, for meeting HCAHPS goals.
It seems a shame that the government or any other entity has to hold healthcare organizations’ money hostage so they do their jobs well, or that the same organizations have to turn around and do the same thing to their employees, but incentives are the name of the game all over the place these days. You would think that simply having a job or a viable business has become a privilege, and that anyone who is lucky enough to stay employed would be willing to do the best they can without needing bribes I know that sounds hard-hearted and insensitive, but it's the truth that many leaders choose to ignore. Maybe those leaders should look in the mirror and ask themselves if they are really incentivizing their people in the right way. Maybe if they trained their people better, bonuses wouldn't be necessary.
The value-based purchasing program almost reeks of a Ponzi scheme, wherein the government takes money from the taxpayer who is already paying high insurance premiums to get the people who run healthcare organizations to do the things they should be doing as a matter of practice.
As healthcare becomes more competitive, with new ambulatory surgery centers and minute clinics popping up almost every day, everyone in the hospital industry should be focused like a laser beam on customer service and shouldn’t need the government to prod them to treat their customers like human beings.
That’s one patient’s opinion, anyway.