Customer Satisfaction and the Quality of Your Health Care

CMSThe Center for Medicare Services (CMS) has issued edicts and guidelines to hospitals that their customer satisfaction survey ratings must improve or else they will be fined and penalized.  One of the areas where they want improvement is in the emergency room or department.  They now require ER’s to make a disposition and either treat you and send you on your way or admit you to stay within three hours (180 minutes). On the surface anyone who has spent time in an emergency room cannot possibly object to speedier more efficient service so why am I objecting to this new regulation?

For decades emergency rooms have practiced the art of triage. Triage means they treat the sickest but most salvageable patients first.  Those with simple non-life-threatening issues and those with severe issues but no hope of survival get placed at the back of the line in deference to sicker individuals with problems that require immediate attention if the patient is to survive. Emergency Rooms have become everyone’s after hours and weekend primary care office for many reasons. They are jammed with minor health problems and social issues that in an earlier less litigious era would have been treated at home by family and friends or seen by the family doctor in the office or in the past in their homes. Many of the reasons for these visits would have been treated with guidelines and instructions available in any Cub Scout or Brownie First Aid instructional manual but today clog the ERs.  Should an abrasion from a fall to the arm of a 12 year old receive the same immediate attention as a change in mental status and collapse of a previously healthy 45 year old father of three?

CMS has not differentiated between University Hospital Centers with fulltime on-site interns, residents and fellows and community hospitals where few if any of the treating physicians are on location full time.  In order to stay in compliance with these draconian rules, community hospitals are diverting doctors and nurses from caring for patients in the facility to the emergency department to “move patients along.”   Our community hospital initially imposed a “thirty minute rule” which said that when a community based physician received a phone call from the ER that a patient required admission they had 30 minutes to admit that patient.   Admitting a patient without seeing them, taking a history and doing an appropriate examination is not in the patient’s best interest. When the medical staff was asked to approve this rule as part of the Medical Staff bylaws, they overwhelmingly rejected it.

Everyone wants prompt, efficient, courteous attention and service especially when ill. CMS and this administration are trying to implement it by decree without true consideration of how their actions will impact patient care. One size does not fit all.  Without citizen outcry to their elected officials, poorly thought-out policy in the name of cost savings will impact you and your loved ones unless you speak up.

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