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Nursing Care, Inpatient Satisfaction, and Value-Based Purchasing: Vital Connections

Wolosin, Robert PhD; Ayala, Louis PhD; Fulton, Bradley R. PhD

Journal of Nursing Administration: June 2012 - Volume 42 - Issue 6 - p 321–325
doi: 10.1097/NNA.0b013e318257392b

Objective: The objective of this study was to investigate how domains of patient satisfaction in hospitals predict Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) global rating scores to support hospital administrators in dealing with reimbursement changes.

Background: Medicare’s inpatient value-based purchasing program ties a portion of hospital payments to scores on the HCAHPS survey.

Methods: Logistical regression analysis of patient-level satisfaction domain scores from a standard, commercially available survey and HCAHPS top-box scores controlled for potential confounding variables.

Results: Each 1-point increase in the nursing domain score increased the odds of achieving an HCAHPS top-box score by 4.9%. Increases in other domain scores also affected top-box odds, although to a smaller extent.

Conclusions: Hospital administrators wishing to maximize Medicare reimbursement will realize the greatest impact by improving patient satisfaction with nursing care.

Supplemental Digital Content is available in the text.

Author Affiliations: Researchers, Research and Analytics, Press Ganey Associates, Inc, South Bend Indiana.

All authors are employees of Press Ganey Associates, Inc.

Correspondence: Dr Wolosin, Press Ganey Associates, Inc, 404 S Columbia Place, South Bend, IN 46601 (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2012 Lippincott Williams & Wilkins, Inc.