A Multiphase Intervention to Increase Nurses' Knowledge and Understanding of Value-Based Payment Associated with HCAHPS Care Transition Scores

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Malley, J., Spicer, J.G., Ramberger, D., & Nguyen, E. (2024). A multiphase intervention to increase nurses' knowledge and understanding of value-based payment associated with HCAHPS care transition scores. Nursing Economics, 42(3), 111-118. https://doi.org/10.621 16/NEC.2024.42.3.111

As health care transitions to value-based payment reforms, registered nurses with appropriate knowledge can reframe the value and financial contributions of their work. This project assessed nurses' knowledge and understanding of value-based payment, the care transitions domain of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and value-informed nursing practice. This exploratory mixed methods study used a multiphase educational intervention with quantitative and qualitative data analysis. Measurements before and after the intervention revealed statistically significant (p < 0.001) changes in nurses' knowledge of HCAHPS, value-based payment, and value-informed practice. Nurses' self-reports supported changes in knowledge. Knowledge of value-based payment models enables nurses to develop value-informed practices and articulate their contributions to patient outcomes and the financial health of their organization.

Keywords: Value-based payment, care transition, value-informed nursing practice, self-report, financial health.

In value-based payment models, payment is predicated on patient outcomes. The Centers for Medicare and Medicaid Services (CMS) implemented value-based payment for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This project assessed nurses' knowledge and understanding of a) value-based payment, b) the care transitions domain in the HCAHPS survey, and c) Stanford Health Care's Welcome Brochure as a value-informed nursing practice.

Value-Based Payment for HCAHPS

The Patient Protection and Affordable Care Act, signed into law in 2010, includes HCAHPS performance in calculating incentive value-based payment in hospital value-based purchasing programs (HCAHPS, 2022). As of April 2022, valuebased payment accounted for 2% of all Medicare hospital reimbursements, of which HCAHPS scores comprised 25% of hospital value-based payment (HCAHPS, 2022). Putting the 2% of payment at risk in context, it is estimated that Medicare spent $353.21 billion on hospital services in 2022 (Peterson-KFF Health System Tracker, 2024).

The HCAHPS survey, which is composed of 29 items, is divided into eight domains: 1) communication with nurses, 2) communication with physicians, 3) staff responsiveness, 4) communication about medicines, 5) discharge information, 6) care transitions,

7) cleanliness and quietness, and

8) hospital rating (HCAHPS, 2022). The care transitions domain is composed of...