Why CMS and Patient Surveys are Killing your Business

Explaining a new concept to those whose new concept quotas are full can be challenging.

Sometimes when I am in a meeting whose tedium has it spiraling into a black hole, I tend to lose my train of thought.  Like the one I was in the other day.   I find myself inventing things to satisfy the voices in my head.  In that particular day, if I had had a box of toothpicks I might have set about building a cold fusion device.  But alas, I was armed with only my wits; in other words, I was helpless.

Undaunted, I began playing a virtual game of Trivial Pursuit with the others who were likewise trapped.  Of the redhead two seats down, I asked the question “Name a reptile with four letters in its name.”  I envisioned her, without thinking, I do not know if this was a genetic flaw or simply a misfiring synapse she replies “Spider.”  I knew at that moment she and I would not be splitting a croissant at the next Mensa meeting.  Then I envisioned her getting mad at me because in front of everyone I would have announced that spiders are not reptiles.  By the time I would have told tell her that ‘spider’ was spelled with six letters I would have been hyperventilating so badly that the meeting coordinator would have had to put a grocery bag over my head—paper or plastic?

So, back to the concept of buying into new ideas.

What if you were asked to become the new manager of the New York Yankees, and before you make your decision you are told you may watch the third inning of each of their games?  Innings one and two, and four through nine were out of bounds.

You had to base your evaluation of the team on only a fraction of the available information. Kind of a silly notion.  Who would want to make a decision with only a fraction of the information?

Almost every hospital in America does that every day when it comes to evaluating patient experience.  They look at a fraction of the information that makes up patient experience.  Why?  Because that fraction is what CMS defined as the entirety of patient experience.  Why else?  Because money is involved.

And here is a little secret that hospital CFO’s and hospital boards have either overlooked or misunderstood.  The amount of the penalty trifles in comparison to the size of the revenue gain that could be made if hospitals focused on patient retention and referrals that could come from satisfying patients.


HCAHPs surveys are like only looking at the third inning of a baseball game to judge how to improve the team.  HCAHPs surveys are based on data that is months out of date.  How does one realistically fix a problem associated with a single patient that happened six months ago?  Don’t believe me?  Can you remember how the service or food was at the restaurant you dined at last December?  Of course not.  If you filled out a customer satisfaction survey tomorrow, would you believe it would change anything at the restaurant based on your six month old experience?  How clear would your recollection be.  What could the restaurant change to make you want to return?  How would you know if they changed it?

This process is fruitless.  The only point, the only reason hospitals address patient experience through the blinders dictated by CMS is because of the penalty.  Ding-dong, Avon (substitute your favorite patient experience data selling firm) calling.  Would you like to pay us for your own data?

I get the impression that saying you do not want to buy patient experience data is like saying ‘no’ to the teenager selling magazine subscriptions.  That firm, you know the one, rings your doorbell and asks, ‘Would you like to improve patient experience?”  Recognize two things.  It is a loaded question—you cannot sleep at night if you say ‘no’.  More importantly, paying for patient experience data year after year has nothing to do with improving patient experience.  Did it improve the experience of your patients?

If the survey data indicated that Nurse Ratched did not smile enough, what course of action did you undertake?  You hired the coaching firm—you know which one, you hired the survey data selling firm—you know which one, and what was the result?  Nurse Ratched smiled.  You spent more than a hundred thousand dollars to find out that Nurse Ratched was the problem and to make sure she smiled.

What did you get for your expenditure as relates to how people perceive your hospital?  Nothing.  Why nothing?  Because the now smiling Nurse Ratched only attends a very small percentage of your total patient population.  Getting her to smile has no impact on the satisfaction of all of the other patients and all of the prospective patients.  There is no ROI on paying for smile coaching or data.

Fixing Nurse Ratched is like basing your decisions on the third inning.  If you only follow the CMS guidelines you will never improve patient experience.  Viewing CMS as though they came down from Mount Sinai with the stone tablets will get you nowhere.  What if in addition to Moses, Fred, Sally, Joe, and Leslie also had stone tablets, but those people stopped to check out the burning bush and were delayed?  I know my analogy is a stretch, but I am writing late at night.

What questions were on the other tablets, what questions is your hospital ignoring?  How about, “Is it easy to do business with the hospital?”  Could you schedule an appointment without spending an hour on hold—could you do it with a click of you mouse?  Did the hospital help you file a claim?  Could you admit yourself the night before on your iPad?

Surveys and CMS do not address the level of dissatisfaction from not being able to do those things.  Forget for a moment that you work at the hospital.  Become a patient.  Show up at six AM, along with all of the other people who were told to be there at six AM.  You and they have not had anything to eat or drink since the night before.  The line to be admitted looks like a Greyhound bus just dropped off forty teenagers at McDonalds.  It reminds you of why airports schedule all of their departures at the same time.  It makes you ask why someone has not come up with a better idea.

What if instead of sitting on the waiting room, waiting to be processed like cattle on their way to the slaughterhouse, you were able to self-admit at a time and on a device of your choosing?  What if you were treated as a customer, a customer whose value over the next twenty years was valued at one hundred thousand dollars; a customer whose family members increased the value of your business by another few hundred thousand?

If hospitals focused on the revenues that could be made instead of the money that might be lost everyone would benefit.

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