Nurse Report Cards, are they coming?

Why are Nurse report cards coming? Besides the fact that most report cards have been mandated by federal and state agencies and the Joint Commission (JC), frankly it’s a great way to measure and create some positive results quickly. It’s also a great way to tout your stuff, so to speak, if you have it.

Hospitals today market for patients and reports cards are a great way to market and compare services. Today's report cards are just beginning to be used by the public but their use will grow and likely will be a basis for P4P (Pay for Performance) by Medicare, HMO's and the hospitals themselves.

Patients want to go to the safest and the best hospitals and receive the best care. Patients know that nurses are responsible in a large way for how well they and their family members do while hospitalized.

At SNI we're exploring a pilot nurse report card for several purposes:

a) Marketing and Leadership: Just like the hospitals, we need to market. After all, when a hospital, health care facility, school, surgi-center, or Walgreen’s outsource nursing, they as buyers want to know they are getting good service and excellent professionals so their dollars are well spent. Differentiating our service and the professional we broker makes a difference and affects decision-making.

Report cards are an easy way to show the number of years of experience, customer service scores, dependability (cancellations), low error rates and competency. Yes, there's that word again, annual competency scores and annual CEUs in specific areas (medication safety, SBAR, medication reconciliation, MRSA, high alert drugs, standard abbreviations) assure the client that you will help them be successful on their report cards. Since facility and procedure report cards are public and affect reimbursement and licensure, good scores are imperative.

b) Continued Joint Commission (JC) recognition and certification: SNI was one of the first eight (8) agencies in the country to become JC certified. Fifty-percent (50%) of all agencies fail (its a pass/fail process). In PA there are eleven (11) JC certified agencies and in NJ there are five (5). Certification is becoming more and more important because it’s the gold standard for hospitals. While it’s a lot of work staying certified, it also provides market differentiation. SNI also participated as one of 20 agencies in the country last year on a new pilot and the measures are a requirement to stay certified. The pilot looked at three areas: credentials, customer satisfaction and competency.

The JC has to be able to see all the credentials required to practice on a contract basis and according to the contract, all must be on file. Random surveys and spot checks are allowable anytime between surveys. While all hospitals and agencies have had problems getting documents on time the standard has become 100% compliance at all times to protect the patients and assure that no one is operating inappropriately. SNI scored way above the norm in this area and was one of the best performers in this region. A fact appreciated by the hospitals since JC frequently performs unannounced surveys and checks credentials at the hospitals end.

Customer satisfaction, hospitals and the JC want to know that an institution is satisfied with the services of an outsourcing company and of the professionals provided. At SNI this means after your first two shifts at a facility and again annually we send customer satisfaction surveys to the institution. The customer satisfaction tool asks the key questions important to the hospitals (i.e., was the hospital happy with your services; did you show up on time; did you have the required skills and knowledge to meet the patient needs in the unit you worked on; were you able to work as a team).

Again, the surveys showed high scores but lateness on the part of a few contractors held us from perfect scores. Competency was noted as a strong point with many hospitals writing testimonials on the experience level and professionalism of contractors.

Competency: competency under the pilot was measured a number of ways; current credentials, orientations, years of experience, active license, CEU’s, skills check list, annual testing in key areas, incident reports, and overall assessment of the hospital with regard to the nurses ability to practice in the designated unit.

Scores received from clients and via annual reviews were exceptionally high (a fact, we use in our marketing to hospitals). The work done to gather this information and keep the database up to date is quite extensive but well worth it for continued JC certification and for providing more opportunities for each of you. We know the paperwork and testing is overwhelming at times but is now necessary to meet the standards instituted nationally. Thank you for your help in getting this important verification done.

c) P4P: Hospital and Physicians are already shifting pay structures to encompass Pay 4 Performance. Many physicians have not had increases form Medicare, for example, for the past three years (this includes cost of living adjustments). Most hospitals have had reimbursement decreased form Medicare overall while certain DRG’s have been adjusted upwards. Medicare and many states are now penalizing hospitals with no pay for wrong site surgeries, infection acquired in hospitals, and med errors that result in prolonged hospital admissions. On the reward side, physicians and hospitals with best practice records are receiving more dollars and eventually will be bonused for their "performance".

In essence, health care is moving to a traditional business model (i.e. reward the performers and keep them healthy so they can serve more patients). While its hard to agree with all the practices going on, its just plain reality. Now, to nurses, some hospitals have already announced no more cost of living adjustments. Instead the employees will be rewarded if the hospital makes their budget (i.e., a pay freeze unless the hospital does well).

On the other side of this equation is reward for professionals who do well and help the hospitals meet goals. While this may seem complicated, I can assure you over time Nurses will also be a part of P4P. SNI would like to tie Nurse report cards to P4P and lead in this area. After all, if you can prove there is a difference, which helps a hospital or a unit excel then you have value beyond the norm.

Marty Minniti

You can contact us at (267) 532-1620 or (800) 284-4764 for more details.