The Key to HCAHPS Ratings: Satisfied Nurses

Nurses play an important role in determining the level of satisfaction patients feel about the care they received while in the hospital.  With reimbursement by Medicare being tied to patient satisfaction through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, how patients perceive their quality of care can have serious financial implications for hospitals.  Improving patient satisfaction has become more critical than ever.

Medicare has reduced its yearly payments to hospitals by 1%, or an estimated $963 million.  That money is distributed to those hospitals with high HCAHPS scores. By 2017, the withholding will double to 2%.


Developed by the CMS (Centers for Medicare and Medicaid Services) and the Agency for Healthcare Research and Quality, HCAHPS is designed to measure and compare patients’ perspectives of hospital care.  As part of the new value-based purchasing program, hospital reimbursements can be reduced based on patients’ survey ratings.  Recently discharged patients are chosen at random and asked to answer a government survey, allowing hospitals to be evaluated and compared on patient satisfaction rankings.

Average hospital performers see reduced reimbursements, with only the top hospitals and those with the highest yearly improvements continuing to receive unhindered reimbursements.

Nurses’ Role

Out of ten key areas where rating measures are evaluated, nurses can impact five:

  • Nurse Communication
  • Responsiveness of Hospital Staff
  • Pain Management
  • Communication About Medicines
  • Discharge Information

More than ever, nurses have a direct, hands-on role in increasing the HCAHPS rating their hospital receives, which means they are key contributors to the financial health of their institution.

Nurse Satisfaction Equals Patient Satisfaction

According to findings from NDNQI, a quality improvement program of the American Nurses Association, positive patient outcomes are strongly tied to nurse satisfaction. When nurse job enjoyment goes up, infection rates decrease by 87% and hospital-acquired pressure ulcer rates decrease by up to 59%, resulting in up to a 20% increase in quality of care.

A similar study in Health Affairs shows that patient satisfaction is lower in institutions where many nurses feel burned out or dissatisfied with their work conditions versus other institutions.

Hospitals’ Role

Hospitals may want to focus on increasing nurse satisfaction as a gateway to improving patient experiences. As nurses have the most daily patient interaction, they truly represent the face of a hospital from a patient perspective.

Rather than overhauling a patient care system, it is recommended that hospitals reevaluate how they use the resources they already have. For example, Patient Experience Officers often recommend that nurses make hourly rounds, rather than wait until the patient rings the call button. Because these checks act as a preventative measure, staffing levels don’t have to be increased and nurses are able to form connections with their patients. Nurses also participate in discharge care and follow-up, helping keep recoveries on track.

By improving nurse satisfaction and optimizing workflows to increase patient interaction, hospitals are able to positively impact patient experiences and improve their chances for greater Medicare reimbursement.

Related Articles:

Medical Scribe Journal


MedPage Today

Huffington Post

USA Today


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