The passage of the Affordable Care Act sparked a series of changes that has resulted in a stronger-than-ever focus on quality patient care.
Thanks to the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program and its Hospital Value-Based Purchasing Program, reimbursement is inextricably tied to quality. Hospitals are penalized when readmission and hospital-acquired condition rates are higher than acceptable, and they are rewarded when performance is deemed above par.
Also impacting hospital pay under value-based purchasing is performance on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS). HCAHPS is essentially a patient satisfaction survey that scores performance in a number of areas including nurse communication, pain management, and overall patient experience. Every day, more than 8,400 of these surveys are filled out by patients across the country, the results of which are tallied and factored into the amount of Medicare reimbursement a hospital receives.
Nurses play a central role in the majority of care areas now scrutinized to determine hospital pay. As a result, any RN working by the bedside is undoubtedly familiar with Medicare’s list of hospital-acquired conditions and has received at least some general input on the need to avoid them.
Like Medicare, smart hospitals are using data to gauge their performance and take steps to improve it. More than 2,000 nationwide currently participate in the NDNQI nursing quality measurement program. Developed by the American Nurses Association, the database collects and tracks nurse-sensitive data for enrolled hospitals.
Participating hospitals receive reports comparing their performance against national, regional, and state norms for similar-type hospitals, all the way down to the unit level for measures such as fall rates, central line-associated bloodstream infection rates, and catheter-associated urinary tract infection rates.
Using these statistics, hospitals can identify specific units and areas where quality improvement is needed. Over time, they will be able to track progress they’ve made in improving them.
NDNQI also offers hospitals access to online learning opportunities covering report interpretation and quality measures training.
And while the cost of enrolling in the NDNQI program isn’t free, membership could actually run less than what a hospital might spend treating just a single inpatient injured in a fall—a hospital-acquired condition for which Medicare no longer pays, but actively penalizes.
For those focused on the bottom line, quality improvements make a whole lot of sense (and dollars) in today’s reimbursement climate.