Better Care Equals a Higher CMS Star Rating

Don’t settle for 1, 2 or even 3 stars.

Since the introduction of The Patient Protection and Affordable Care Act (ACA) in 2012 the amount of information regarding measuring, considering, improving, transforming, coordinating, and discussing quality of care and patient experience has been immeasurable!

Healthcare professionals have been so intent on improving their numbers they may have forgotten how these measures came to be so important.

Of course, the number one reason is that the government mandates all hospitals and health systems to assess for quality and patient satisfaction. 

The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. 

But they also apply reimbursement penalties to organizations that fail to meet certain expectations. 

It has always been a moral imperative for hospitals and health systems to provide a high-quality patient experience, but now that the Centers for Medicare & Medicaid Services is tying reimbursements to HCAHPS scores, it's becoming a financial priority, as well.

In addition to being a source of pride for the organization, these numbers help protect revenue.

Improving processes to take care of patients throughout the patient’s entire continuum of care also helps financially.

While the financial benefits of improving the patient experience are harder to analyze than HCAHPS scores, meaningful economic gains are being made. Hospital CFO’s report a definite return on investment and the aversion of hundreds of thousands of dollars in losses by improving value-based purchasing metrics.

Improvements in the quality star rating also increase the rebate percentage, resulting in increases in revenue.

Even a small increase in revenue can be a significant advantage in a competitive market. In certain competitive markets, achieving an extra 1 percent of revenue over competitor organizations may be just enough to offer an extra benefit or lower premium to make an organization more attractive.

A recent Yale School of Medicine study found that hospitals financially penalized under the Hospital Readmission Reduction Program reduced their readmission rates at a higher rate than non-penalized hospitals.

Still, Medicare readmission penalties could surpass $500 million per year with over 2500 hospitals being punished. 

And, fewer hospitals receive bonuses from the hospital value-based purchasing program.

In fact, hospitals that earned bonuses in previous years are often docked in current years.

The amount withheld could be 2% of Medicare payments, 22% of which is tied to Patient Experience.

See how to improve Patient Satisfaction without increasing costs in the free ebook here.

Sources

CMS rewards 1,600 hospitals with $1.8 billion for quality care. Modern Healthcare. http://www.modernhealthcare.com/article/20161101/NEWS/161109986. Published November 1, 2016. Accessed May 19, 2017.

Haefner M. 769 hospitals see Medicare payments cut over high HAC rates: 7 things to know. Becker's Hospital Review. http://www.beckershospitalreview.com/quality/769-hospitals-see-medicare-payments-cut-over-high-hac-rates-7-things-to-know.html. Published December 22, 2016. Accessed May 19, 2017.

Harting L. Better HCAHPS Scores Protect Revenue. Better HCAHPS Scores Protect Revenue | HealthLeaders Media. http://www.healthleadersmedia.com/finance/better-hcahps-scores-protect-revenue. Published September 28, 2016. Accessed May 19, 2017.

HCAHPS: The True Impact of Patient Satisfaction. ScribeAmerica. http://scribeamerica.com/blog/hcahps-true-impact-patient-satisfaction/. Published September 9, 2014. Accessed May 19, 2017.

Patient Satisfaction Reporting and Its Implications for Patient Care. The AMA Journal of Ethics. 2015;17(7):616-621. doi:10.1001/journalofethics.2015.17.7.ecas3-1507.

Rau J. Medicare’s Readmission Penalties Hit New High. Kaiser Health News. http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/. Published August 18, 2016. Accessed May 19, 2017.

Rosin T. Patient experience and quality impacts on reimbursement: 5 things to know. Becker's Hospital Review. http://www.beckershospitalreview.com/hospital-physician-relationships/patient-experience-and-quality-impacts-on-reimbursement-5-things-to-know.html. Published February 18, 2015. Accessed May 19, 2017.

Rosner C. 14 Hospitals Cited For Infections, Injuries Lose Some Medicare Funding. courant.com. http://www.courant.com/news/connecticut/hc-hospital-infection-penalties-20170105-story.html. Published January 5, 2017. Accessed May 19, 2017.

Sun LH. Patient satisfaction, long ignored by health-care industry, now a priority. The Washington Post. https://www.washingtonpost.com/national/health-science/sites-like-yelp-can-be-tough-but-hospitals-embrace-online-reviews/2015/06/03/a07a68b6-fe63-11e4-805c-c3f407e5a9e9_story.html. Published June 3, 2015. Accessed May 19, 2017.

Wessels G. How HCAHPS is Impacting Hospitals Financially. RSS2. http://www.totalinnovationgroup.com/blog/how-hcahps-is-impacting-hospitals-financially/. Published December 1, 2015. Accessed May 19, 2017.

Www.cms.gov. center for clinical standards and quality, centers for Medicare & Medicaid services; 2015. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualitymeasures/downloads/2015-national-impact-assessment-report.pdf. Accessed May 19, 2017.

Xiong A, Amy Xiong Jan 17, 2017. Medicare penalties lead to decline in hospital readmission rates. Yale Daily News Medicare penalties lead to decline in hospital readmission rates Comments. http://yaledailynews.com/blog/2017/01/17/medicare-penalties-lead-to-decline-in-hospital-readmission-rates/. Published January 17, 2017. Accessed May 19, 2017.