HCAHPS are Destroying Healthcare




For those of you who don’t already know, HCAHPS are basically fancy scoring cards for hospitals. When patients are discharged they receive questionnaires that gauge how the hospital handled their care from start to finish.

Those questionnaires all get sent to the government and sorted where they comprise a ranking of all of the hospitals in the nation (that participate with Medicare and Medicaid insurance–so almost all of them). Now depending on the hospital’s final score, they may or may not receive reimbursement for services performed. Wait, what?


Yes, you heard that right. A hospital could perform lots of life-saving heart catheterizations, for example, but if the patients are unhappy throughout their stay, the hospital might not get paid for doing that work. On the flip-side, hospitals that cater to patients’ every desire might score higher on HCAHPS, and receive not only the money that they spent on patient care but extra from all of the other hospitals that didn’t get high reviews.

Is it surprising to anyone that government involvement in healthcare is a bad idea? Time and time again we have seen the private sector outperform the government due to its inherent efficient, fast, and smart design. The government, in contrast, is bloated, sluggish, and stupid… but let’s let them run healthcare because they’re doing such a bang-up job with the DMV.

So what do you think hospitals do about this? That’s right, they bend over backward as far as possible making patients happy, and end up opening the doorway to all kinds of problems.

Unnecessary Testing

I love Wikipedia and WebMD, but let's face it, I'm a well educated RN with years of education and experience working in healthcare. So when I use these websites, first I look for credible references to validate the information, and secondly, I'll have a better idea of what to do with the information than most laypeople. When a hypochondriac starts reading about the signs and symptoms of the common cold, they may mistake this for cancer, TB, maybe even Ebola... who knows what people can imagine when they're scared?

By demanding doctors order tests for what patients THINK they have, patients end up wasting time and money by not letting the professionals do what they do best. There is no need for running a myriad of inordinate tests when there may be simpler, cheaper, and faster tests available.

But because we let ignorant patients be the boss and healthcare providers are getting sued left and right, we have one of the most expensive healthcare systems in the modern world. Let your healthcare team do their jobs!

Overuse of Controlled Substances

A trending theme seems to be the over prescription and use of controlled substances. Pain medication is one of those touchy subjects due to frequent abuse, yet plenty of patients truly need lots of pain medicine. Pain meds become problematic when patients start using it excessively and end up prolonging their own care. I've heard of patients that postponed working with physical therapy until they had been heavily sedated with pain medicine first. At this point, they were no longer able to fully participate with PT.

I had a patient who told the doctors that the Librium he was taking for alcohol withdrawal wasn’t working. The very fact that he was rationally explaining this was proof enough that it was indeed doing its job, but he just wanted to be snowed on Ativan. And guess what… that’s exactly what ended up happening after his physicians caved into his demands.

Because of HCAHPS, patients are able to push medical professionals around and get what they want despite the fact that it isn’t always in their best interests (medically speaking). This is especially concerning for nurses, as we are ultimately responsible for our patients’ safety and sometimes the number of medicines they are ordered is just plain dangerous. And I don’t know about you, but I don’t want to lose my license just so my patients can get high.

Scripted Interactions

It might be hard to comprehend, but it's actually true that many hospital corporations are buying products that "coach" staff on how to respond to patients on a variety of topics. Instead of spending the millions of dollars that they are throwing away on these acting classes, they could be hiring more staff which has always been shown to improve EVERYTHING, but no. Instead, they are choosing to replace normal individualized human interaction with scripted lines and phrases... like a robot.

I have had multiple managers tell us to parrot Chick-fil-A and their trademark employment slogan/response of “My Pleasure!” :robot: [insert smile here]. During a mandatory education course, I was forced to watch a Domino’s Pizza advertisement showing how they turned their business around. The presenter then went on to ask the class what we learned from the video. I understand that hospitals want to create good customer service, but comparing fast food companies to hospitals is utterly ridiculous, and downright insulting.

These scripted interactions are being implemented to try to increase ratings by secretly tricking patients into believing their hospital experience has been excellent through subliminal advertising. For example, keywords such as “hourly rounding,” “medication side effects,” and “bedside reporting,” are to be mentioned frequently during a patient’s stay. This is because patients will be specifically questioned on those topics when discharged, and more likely to score the hospital favorably if they have been exposed to these terms on a regular basis.

Increasing the Burden on Nursing

I slightly touched on this earlier, but when your goal is to just make people happy many hospitals might start cutting corners. Moving staff around to do jobs that are less medically important than what they might otherwise be doing is now commonplace.

I have been seeing an increasing amount of nurse aides, techs, CNAs, etc., being pulled from their normal duties, to start going around throughout the hospital serving people refreshments, fluffing pillows, and essentially being room service. Now, this may sound nice, but it ends up creating a void that nursing ultimately has to cover, as we now have to do all of our previous work, in addition to all the duties that these staff members were handling.

All too often it seems like there are more and more things being added to the list for nursing to take care of. But along with this seemingly never-ending expansion of our job descriptions, I’ve never seen a salary boost to justify it, nor some extra hands on deck to make up for the increased workload. Just another example of how the burden on nursing continues to grow.


In conclusion, I would like to have patients understand that they are going to a hospital, not a hotel. Instead of having to be a whim catering server robot, with extensive drug dispensing functionality, I would just like to be a nurse. Thoughts?

Everything You Need to Know About HCAHPS
Everything You Need to Know About HCAHPS


I blame tort lawyers for the ridiculous state healthcare finds itself in. Around every corner, their lies a lawyer waiting to sue someone for anything.


They make the nurses mop the floors at Vanderbilt because of budget cuts. What a joke! I would be furious if I worked my ass off to get a BSN so I could work as an RN at an academic hospital just to be handed a mop :angry:


I love this :rofl: