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HCAHPS Changes: The Difference Between Thousands of Dollars Lost and Thousands of Dollars Gained for Hospitals

By: Leslie Nettelmann

It is more important than ever for hospitals to make the patient experience a focal point. By assessing the management of the overall patient experience and expectations, implementing new technologies, addressing staffing issues, and streamlining supply purchasing, Soriant can help your institution improve customer and patient satisfaction and maximize Medicare reimbursement.Patient Care

The hospital experience for most of us is frightening and foreign. We assume quality care will be provided to us because it is difficult (barring the obvious) to evaluate it otherwise. So, we assess what we feel we can: our interaction with other people, the level of cleanliness, whether or not we liked the food. However, it’s how we are treated that ranks at the top of the list, though we still expect cleanliness, good food, and a well functioning facility.

Patients’ interaction with doctors, residents, nurses, and technicians may influence their perception of care. What’s recognized less frequently is that their interaction with environmental services, food services, and other support staff may enhance or diminish their perception of the quality of medical services. The interaction with others helps determine whether patients feel valued, respected, and cared for—not only as a patient but also as an individual; whether their fears are reduced or exacerbated; whether they ultimately feel “satisfied” with the hospital experience.

A 27-question post-discharge survey of patients asking for feedback about their inpatient stay through HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) was developed by CMS (Centers for Medicare and Medicaid Services). It is designed to compare hospital satisfaction results on a local, regional, and national level (HCAHPS, 2012, pp. 1-2). This satisfaction comparison data can give customers information from which they may make decisions about future hospital stays. When a hospital stay is needed, consumers will be able to see which facility in their area has the best satisfaction ratings. This will generate good competition and give more control to the consumer.

Additionally, the survey contains clinical quality data that will further affect reimbursement in 2013 (beginning with October-December 2012 results). This impact to Medicare reimbursement will extend beyond the requirement of publicly reporting data to the inclusion of HCAHPS performance in the value-based incentive payment in hospital VBP (Value-Based Purchasing) under the Patient Protection and Affordable Care Act of 2010 (HCAHPS, 2012, pp. 1-2). HCAHPS measures the frequency with which identified satisfaction occurs—rated as always, sometimes, or never—with always being the intended and desired outcome.

Many hospitals have implemented a variety of tools to improve satisfaction. Using HCAHPS information to understand and increase satisfaction has real value, but achieving high HCAHPS scores alone should not be the sole basis for modification or improvement. Implementing changes to all aspects of the delivery to convey authentic respect, courtesy, understanding, and communication throughout an inpatient stay must be the goal.

Scores will likely improve. Many satisfaction-improvement tools, from team building to scripting and more, have not fully addressed social skills required to be a good listener, to convey respect to the patient and other staff, and to communicate to individual patients that they are valued—that they matter. Many assume staff (regardless of position) come to the job with social skills that some use well, but others do not—through willful resistance, laziness, or other intentions. The result is many staff fail to engage with patients and with each other.

My expertise is in teaching social skills. This is a time consuming but lasting, results-producing endeavor. It provides confidence, skill, and knowledge; displays to the staff that they are valued by hospital administration; and offers the opportunity to help improve patient satisfaction through courtesy, respect, and good listening, and ultimately, valuing the patient and establishing trust. It helps build personal presence, form the basis for engagement with others, deliver “confirmation” to hospital staff/caregivers, thus generating opportunities to provide patients with positive human encounters (Eriksson and Svedlund, 2007, pp. 2-3).

Teaching and acquiring social skills produce a work environment that is friendly and positive, supportive and caring. This environment with quality customer care, coupled with great food and an efficient, clean environment leads to a level of patient satisfaction that will contribute to the choice of hospital in the future. Each individual patient’s satisfaction will influence the hospital selection for his or her friends, neighbors, and family, as well.

Being recognized as a hospital with a high level of patient satisfaction will help increase volume, revenue, and resources while enhancing community standing. It is the hallmark of care.


Eriksson, U. & Svedlund, M. (2007). Struggling for confirmation-patients’ experiences of dissatisfaction with hospital care. Journal of Clinical Nursing 16, 438-446.

HCAHPS Fact Sheet (CAHPS Hospital Survey) (2012).

Mulcahy, L. and Tritter, J. Q. (1998), Pathways, Pyramids and Icebergs? Mapping the Links Between Dissatisfaction and Complaints. Sociology of Health & Illness, 20: 825–847



Leslie Nettelmann is certified by the Protocol School of Washington as a corporate consultant in business etiquette and international protocol.  She spent twenty-five years in administrative/executive positions at Allegheny General Hospital in Pittsburgh, thirteen as vice president of operations.  Leslie has a B.A. from the University of Pittsburgh and a M.S. from Duquesne University in Leadership and Business Ethics.
















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