Website spotlight: Does better service excellence mean better care quality?

Staff Development Weekly: Insight on Evidence-Based Practice in Education, July 22, 2011

How many of you have had your inbox flooded with the announcement of final rules for value-based purchasing (VBP), or better yet, the hundreds of media stories and blogs about the sentiment toward them? The reactions of leaders have ranged from enthusiastic and supportive to pessimistic about the effectiveness and required bureaucracy to make VBP operational over the next three to five years. While many of the measures are explicitly linked to quality, a large portion of the program is dedicated to service excellence and patients' perception of care. There appears to be a division among healthcare professionals about the relationship between patients' perception of care and the true nature and quality of care delivered. Do these measures appropriately reflect the quality of care delivered?

The service excellence component of value-based purchasing is the HCAHPS survey. This survey measures patient experience and satisfaction with the hospital. The goal of the survey, whose results are published publicly, is to help consumers make informed choices about where they receive healthcare. It has been one of the first apples-to-apples comparison tools for consumers to use when making healthcare decisions. Administered to discharged patients, the survey consists of 27 questions that relate to the hospital stay, such as communication with doctors and nurses, pain management, and overall hospital ratings. Results of the HCAHPS survey are linked to the rewards and penalties hospitals receive in the new VBP program.

One of the most interesting aspects of the final rules for VBP is the debate about whether scores are a true reflection of care quality. With HCAHPS scores now representing a large portion of hospital reimbursement at risk, the inclusion of these scores in reimbursement-based decisions is now justified. Longtime advocates and supporters of the survey strongly link positive survey results to better clinical outcomes for patients.

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