Exploring the Impact of Telehealth on Patient Care- A Contemporary Trend in Healthcare Delivery
The contemporary issue/trend that student nurses chose fell under the Quality and Safety in Healthcare Delivery category. The student nurse was interested in learning more about a new thought that patient satisfaction, mainly relating to the Emergency Department (ED), is the most critical factor in effective healthcare. In her personal opinion, from the experience of working in an ED for the past year, doing something that will make the patient comfortable is not the best as far as the overall health of the patient goes. Also, in today’s entitled society, patients expect to be waited on hand and foot and immediately upon their request. That is not a realistic expectation in general, let alone with the increasing nursing shortages.
Since the 1980s, interest in the measurement of patient’s satisfaction with their healthcare experiences has increased following reports that high patient satisfaction is associated with excellent health outcomes. This has not been universally accepted; however, the debate over using patient satisfaction ratings as a quality of care marker proceeds.
In March 2012, a study published in the Archives of Internal Medicine made questionable participation in the debate. Joshua J. Fenton, MD, MPH, reported the results of the analysis of data from more than 50,000 adult patients indicating that the most satisfied patients were 12% more likely to be admitted to the hospital. Also, they had both total healthcare expenses and prescription drug expenses that were 9% higher. Most mystifying to many readers at the time, these patients were also 26% more likely to die. These findings were derived from assessments of patient satisfaction based on five items from the Systems (CAHPS) survey, Consumer Assessment of Healthcare Providers, and healthcare utilization one year later.
Among the strengths of the study were its nationally representative sample and adjustment for potential confounders, such as insurance status, sociodemographic characteristics, chronic disease burden, availability of a usual source of care, health status, and first-year health care utilization and expenses. These changes were the basis for some immediate and later criticisms of the study, which cited other studies that found higher patient satisfaction associated with favorable outcomes, including lower inpatient mortality rates. In reply, Dr. Fenton and his co-authors pointed out that when they excluded the sickest 5% of patients who reported high satisfaction from their analysis, the association between higher satisfaction and mortality grew even stronger.
When the Department of Health decided to base thirty percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that clarity and accountability would gain healthcare. The Centers for Medicaid and Medicare Services (CMS) officials wrote, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” CMS probably had no idea that their methods could end up indirectly hurting patients.
In October 2012, the Affordable Care Act implemented a policy withholding 1 percent of total Medicare reimbursements, approximately $850 million, from hospitals (that percentage will double in 2017). Each year, only hospitals with high patient satisfaction scores and a measure of top performers will receive bonus money from the pool and specific primary care standards will earn that money back. The potential cost of the subjective scores is supervising hospitals to direct focus away from patients’ health, messing with the highest sticks possible people’s lives.
In this article, titled “The Problem with Satisfied Patients,” Alexandra Robbins wrote about the economic incentive hospitals face to increase patient satisfaction scores. This issue is a high stake for hospitals, as their bottom line regarding Medicare dollars is now tied to patient satisfaction scores. Most of these scores, derived from a patient survey called HCAHPS, rely on the ratings of nurses.
For instance: “During this hospital stay, after you pressed the call light button, how often and how soon did you get help as soon as you wanted it?”
This sounds fair on the surface, but then look deeper to see what sorts of concerns patients were worried about when they rated nursing care poorly in this section. Again, from the
Atlantic:
“My roommate was dying all night, and his breathing was very ”
“The hospital does not have Splenda.” The nurse at the New Jersey hospital needing Splenda said, “This somehow became the fault of the nurse and ended up placed in her personnel file.”
An Oregon critical-care nurse had to argue with a patient who believed he was mistreated because he didn’t get enough pastrami on his sandwich.
In fact, the national study directed by Dr. Fenton showed that patients who reported being most satisfied with their doctors had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as happy. Worse, the most satisfied patients were significantly more likely to die in the next four years.
Dr. Fenton said these results could reflect that doctors who refunded according to patient satisfaction scores may be less likely to inform patients about treatments that they request or to raise concerns about substance abuse, smoking or mental health issues. By trying to satisfy patients, healthcare workers unintentionally might not be looking out for their best interests. New York Times columnist Theresa Brown observed focusing on what patients want a specific test, a particular drug—may mean they get less of what they need. In other words, evaluating hospital care regarding its ability to offer specific experiences will merely put stress on the system to do things it can not, at the expense of what it should.
The conclusion, there is too much weight placed on the significance of patient satisfaction scores. The student nurse does not feel as though they should use it in planning a hospital’s reimbursement. If they remain to have such an impact, there are two significant consequences student nurses foresee. In the second scenario, the healthcare providers will likely lose their jobs as well and possibly end up turning to ways of doing whatever the patient wants. Either healthcare staff will become more careless with medical treatments to satisfy the patients and receive high satisfaction scores, or they will stick to their guns, resulting in lower patient satisfaction scores, and the hospital will lose money.
References
Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care 2011;17:41-48
Bertakis, K. D., & Azari, R. (2011). Patient-Centered Care is Associated with Decreased Health Care Utilization. The Journal of the American Board of Family Medicine, 24(3), 229-239. doi:10.3122/jabfm.2011.03.10017
Brown, T. (2012, March 14). Hospitals Aren’t Hotels. Retrieved from http://www.nytimes.com/2012/03/15/opinion/hospitals-must-first-hurt-to-heal.html? version=meter at null
Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med2012;172:405-411
Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The Patient Experience and Health Outcomes. New England Journal of Medicine N Engl J Med, 368(3), 201-203. doi:10.1056/nejmp1211775
Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2010;3:188-195
Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. N Engl J Med 2008;359:1921-1931
Robbins, A. (2015). The Nurses: A Year of Secrets, drama, and Miracles with the Heroes of the Hospital. New York, NY: Workman Publishing Company.
Sequist, T. D., Schneider, E. C., Anastario, M., Odigie, E. G., Marshall, R., Rogers, W. H., & Safran, D. G. (2008). Quality Monitoring of Physicians: Linking Patients’ Experiences of Care to Clinical Quality and Outcomes. J GEN INTERN MED Journal of General Internal Medicine, 23(11), 1784-1790. doi:10.1007/s11606-008-0760-4
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Question 
In this written assignment, identify one specific contemporary issue or trend that you are interested in learning more about. Choose from the categories below.
Contemporary Issues And Trends
Global Healthcare and Nursing
Healthcare Reform
U.S. Healthcare Financing
Nursing’s Role in the U.S. Healthcare System
Integrative Healthcare
Nursing Leadership and Management
Nursing Education
Nursing Practice
Nursing Professionalism
Advancing Nursing as a Profession
Client Access to Care
Delivering Client Care
Interdisciplinary Teamwork and Collaboration
Ethical Practices in Healthcare
Quality and Safety in Healthcare Delivery
Health/Nursing Informatics
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