New Medicaid/Medicare Program Puts Pressure on Health Care Hiring

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The Affordable Care Act – or Obamacare – has held the nation’s collective conscience for the past year, but there’s another government program that will also dramatically affect the health care providers and their patients.

It’s called the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS (pronounced H-caps), and it is forcing hospitals and health care organizations to pay closer attention to how their employees interact with patients, because it ties patient satisfaction directly to Medicaid and Medicare payment reimbursement.

The HCAHPS survey is the first national, standardized, publicly reported survey of patients’ perceptions of their hospital experiences. The survey includes questions on eight measures ("dimensions") including communication with nurses, communication with doctors, staff responsiveness, pain management, communication about medicines, and discharge information; a composite that combines cleanliness and quietness items; and an overall rating for the hospital.

Scores on the surveys are extremely important because they affect a health care organization’s Medicare and Medicaid reimbursements. In fact, up to 2 percent of all of a health care organization’s Medicare and Medicaid reimbursements are tied to its HCAHPS scores. For the average U.S. hospital, this can mean anywhere from $100,000 to more than $6 million in reimbursements a year, depending on the size of the facility.

Hospitals, health care organizations, and their human resources departments can positively affect their HCAHPS score if they consider the following advice.

1. Behavioral skills really matter when it comes to patient care. While top-notch technical care continues to be essential, the way in which it is delivered is just as important, especially at hospitals. A doctor or nurse who enters a patient’s room to perform procedures without thought of the patient’s overall experience can do more harm than good because that experience can negatively impact the hospital’s HCAHPS outcome scores.

2. The focus on hiring in health care needs to broaden. The profession has gone to great strides to develop educational programs, licensures, and certifications to ensure quality technical skills. As a result, health care organizations have focused on screening potential employees based on their qualifications and certifications which represent what they "CAN DO." Yet, selection research has increasingly demonstrated the importance of employees’ attitudes toward work (i.e., what they "WILL DO") on overall performance.1,2 Unless they broaden their focus, health care organizations may overlook critical components of employee effectiveness.

3. Ongoing staffing shortages must be addressed.Health care has faced a shortage of nurses for a number of years. A 2012 study3 found that nurses who are more qualified and have higher performance scores are more likely to leave an organization when they are short staffed. Think about that – when a health care institution has a staffing shortage, it is more likely to continue to lose people, including its solid performers.

4. Organizations must do a better job in hiring new employees. A 2008 study4 indicates that health care organizations are not using good techniques to find new nurses and are spending more and more money trying to replace them. In many instances, hospitals have had to consider alternative staffing strategies, including traveling nurses, international employees and part-time staff to meet their needs. With those challenges, it is difficult to expect hospitals to raise the standards for the people they do select.

Pre-employment testing may be one solution to helping health care institutions hire employees who will make a positive impact on their HCAHPS scores. At EASI·Consult®,we recently completed a Return on Investment (ROI) study among nurse leaders at a large hospital chain on the West Coast and found that the use of a pre-employment screening tool resulted in an annual increase in productivity equal to more than $10,000 per new hire. For non-supervisory health care workers, an annual increase in productivity of about $3,500 can be expected when using a pre-employment screening tool. This is consistent with findings from a study we’ve done across manufacturing organizations.

In general, we’ve found that health care organizations seem to be adopting the use of pre-employment surveys more slowly than other private sector industries.

Whatever the future holds for health care hiring, focusing on technical skills alone when hiring for unfilled positions will not be adequate under HCAHPS. That much is clear. But just as important, better health care hiring practices also have the potential to positively affect your experience the next time you or a loved one checks into a hospital.


1Barrick, M. R., & Mount, M. K., (1991) The Big Five personality dimensions and job performance. Personnel Psychology, 44, 1-26.

2 Brown, K.G. & Stizmann, T. (2011). Training and employee development for improved performance. In Zedeck, S. (Ed.) Handbook of Industrial and Organizational Psychology, Vol. 2 (pp. 469-503). Washington, DC: American Psychological Association.

3Toh, S.G., Ang, E., & Devi, M.K. (2012). Systematic review on the relationship between the nursing shortage and job Satisfaction, stress, and burnout levels among nurses in Oncology/Hematology settings. Journal of Evidence Based Healthcare, 10, 126-141.

4Jones, C.B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38, 11-20.

EASI·Consult®works with Fortune 500 companies, government agencies, and mid-sized corporations to provide customized Talent Management solutions. EASI Consult’s specialties include individual assessment, online employment testing, survey research, competency modeling, leadership development, executive coaching, 360-degree feedback, online structured interviews, and EEO hiring compliance. The company is a leader in the field of providing accurate information about people through professional assessment. To learn more about EASI Consult, visit, email or call 800.922.EASI.