HEALTHCARE CONSUMERS Medicare's vision of value-based care takes patient satisfaction and customer service into account.

Whether you work in an ambulatory surgical center or hospital, reimbursements are based on what patients think about the care they received. If enough of your patients are dissatisfied with their treatment, Medicare is going to penalize your facility by withholding part of your reimbursement. Here are a few gestures, both big and small, you can make to calm and comfort your patients before surgery.

• Narrate the care. Sure, inserting an IV or prepping the surgical site may be old-hat to your staff, but it's likely your patient is curious (and maybe a little freaked out) about everything they're stuck with/attached to/prodded by in the run-up to surgery — even if they don't ask. This is why it's so important to explain every step of the process in layman's terms as it's happening, and in a calm, confident voice.

"This is especially true when it comes to changeover of care," says Jeffra Kinniard, BSN, RN, CNOR, ONC, director of operations at Parkview SurgeryONE in Fort Wayne, Ind. "White Coat Syndrome is real — a patient's blood pressure goes up when they see a new physician. It helps to talk one another up, saying something like: 'Michelle is coming to relieve me — she's just the best.'"

Research shows that, even if they're made aware, many patients are rarely able to remember their physicians' names or identify their roles, which can increase anxiety. To help with this, Parkview SurgeryONE has begun using whiteboards in their pre-op bays, which display the names — or, in some cases, nicknames — of the relevant nurses, surgeons, anesthesiologists and certified registered nurse anesthetists. This way, patients feel more connected, and more comfortable asking questions.

• Keep them warm. The more nervous patients are, the colder their extremities will be. As part of the fight-or-flight response, anxiety redirects blood flow from the hands and feet to the body's major organs. For this reason, staff at the Casper (Wy.) Surgical Center make sure to closely monitor the temperature of the pre-op area. They also offer 100% cotton, heated blankets to patients as they wait. "We'll put as many as 3 or 4 on one person, or however many it takes to make them comfortable," says Deb Ukele, RN, BSN, the director of nursing. "We have a big ottoman — about 6 feet by 3 feet — and sometimes they'll curl up on that and go to sleep until it's time for surgery. The more relaxed they are, the easier they'll go under with anesthesia."
• Remember the family. The information patients receive before surgery can be overwhelming — while they're worried about making it through their procedure without complications, they're also supposed to internalize post-op instructions, as well as information about rehab programs and medication schedules. Having a loved one along during pre-op consults for support — and to serve as a second set of ears — can be beneficial.

At Monterey Peninsula Surgery Centers (MPSC) in California, one of the largest locally owned and operated surgery centers in the United States, bringing this "coach" along for the pre-surgery education course isn't just recommended — it's mandatory.

"There's a strong correlation between patient outcome and family support," says Hilary Galbraith, MBA, VP of operations at MPSC. "And our goal is always to ensure patients have the best outcome possible."

Coaches are also required for anyone traveling to MPSC from out of town — in the past 5 years, the facility has treated people from 47 states and 10 countries. Recently, MPSC has started offering these patients and their families the services of a concierge who will help make travel arrangements, book accommodations, even make recommendations for a great Italian restaurant, if that's what's wanted. While the patient is in surgery, the family is free to explore Monterey — an MPSC employee will call when it's time to come back.

• Demystify the money. Another tenet of MPSC ideology is that surgery costs should not be a complicated and mysterious puzzle to be solved after the fact. "We're totally transparent," says Monterey Peninsula CEO Tom Wilson. "We want to demystify surgery, including its cost."

To that end, the billing department looks into the insurance plan of each patient so that, ahead of the surgery date, everyone receives a phone call with a breakdown of price — what they're liable for, and what insurance will cover.

The facility also offers a bundled payment option for the facility fee, surgeon fee, anesthesia fee, and the cost of any implants or supplies, so that bills aren't trickling in one by one.

"As the healthcare industry becomes more complex and patients are increasingly taking on more responsibility for their care, they're doing more research and looking around for their best options," says Ms. Galbraith. "They should be empowered to make the best decisions." OSM

PAY FOR PERFORMANCE
How Patient Satisfaction Impacts Reimbursement

PERCEPTION OF CARE Patient satisfaction now factors into Medicare reimbursement for surgical facilities.

• Hospitals. Beginning this year, Medicare is tying 2% of reimbursements to results of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) customer satisfaction survey (hcahpsonline.org). The 32-question survey is administered to a random sample of patients continuously throughout the year. CMS publicly reports the results, and pays out the bonus money accordingly. Each year, only hospitals with high patient-satisfaction scores and a measure of certain basic care standards will earn that money back, and the top performers will receive bonus money from the pool.
• ASCs. Beginning in 2018, for ASCs to receive the full annual update to their annual payment rate for that year, they must fulfill the reporting requirements of the Ambulatory Surgical Center Quality Reporting (ASCQR) program. Initially, ASCs will be considered to be in compliance when they contract with an appropriate vendor and collect the required number of completed surveys, says the Ambulatory Surgery Center Association (ASCA), adding that Medicare payment determinations will be made based only on compliance and noncompliance, not on the scores the ASCs receive from patients. ASCs that don't meet the reporting requirements, including allowing the data to be publicly available, may incur a 2.0 percentage point reduction to any payment update for that year. Participation in ASCQR is voluntary in 2017, but mandatory beginning in 2018, says ASCA. Medicare has yet to indicate whether it will ever require ASCs to attain certain scores on these surveys.

— Dan O'Connor