Health Care Quality

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Health Care Quality Management

Professor YDD
Fall 2013

This paper examines area of quality and patient satisfaction linked to reimbursement in the article by Nanda, Malone and Joseph (2012), where they describe strategies for changes needed in Health Care Design in response to the Affordable Care Act. The article notes that the main shift in reimbursement model will be tied into financial reward for patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) which aligns with the Institute of Medicine (IOM) patient centered care, one of their quality improvement aims. The PRWeb (2013) in Washington DC reports the reimbursement as follows “the reduction in hospital revenue, based on performance, may be 1.0% in 2013, 1.25% in 2014, 1.5% in 2015, 1.75% in 2016, and 2% for 2017 and subsequent years. For the year 2013, this represents $1 billion at stake”. Patient satisfaction is strong metric for measuring performance. My reaction to this is simply that measuring patient satisfaction probably the least reliable way of measuring quality, especially when we are asking for responses from patients that addresses an experience that is personal and is at most level impacted by emotions, fear and possibly changes in their lives related to illness, surgery and other medical issues. Given the spectrum of patients in United States we have not accounted for cultural differences, expectations and compliance with care. Are the patients responding to the surveys which measure satisfaction and experience responding based similar expectations and outcomes? In the study done by Wall, Tucker et al (2013) from John’s Hopkins University they found that “Patient health care satisfaction fully mediated the relationship between patient- perceived cultural sensitivity of front desk office staff and patient treatment adherence. The patient satisfaction and cultural sensitivity variables explained 10% of the variance in patient treatment adherence. Training front desk office staff in patient- centered culturally sensitive health care may improve patients’ health care satisfaction and treatment adherence.” Another study by Mc Gregor, Dore et al (2013), An Exploration of Patient’s expectation and Satisfaction with Surgical Outcomes finds “that differences existed in the satisfaction with outcome between the two surgical populations, with discectomy patients clearly having higher satisfaction levels. Few studies have explored the influence of surgical procedure apart from Toyone et al. (2005), who also noted higher levels of satisfaction in the discectomy population with little difference in pre-operative expectation between the two groups. It is not clear from either study why this difference occurs; however, in our earlier outcome study it was observed that patients having discectomy did achieve better outcomes than those having decompression which may relate to the underlying physiological process and the differences in age between the two populations”(p2841-2842). Aside from culture and expectations, Patient surveys are not separated by age groups or diagnosis which based on the orthopedic patients in the surgical study there are differences in responses even by types of procedures done. Elective surgery is as standardized as you can get in patient’s journey through the healthcare process. This highlights how difficult it will be to measure patients’ satisfaction in a global way and why I do not think it should be tied into reimbursement. Another reason for not using satisfaction score in determining reimbursement is related to the way in which the surveys are 1) administered and 2) the way peoples’ responses change over time. Zaller and Feldman (1992), A Simple Theory of Survey Responses addresses and the American Statistical Association (ASA) Psychology of Survey Response Webinar (2010) both address the way in which surveys are answered....
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