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Educational delays can exist for several reasons. People with mental health issues like depression and anxiety are less prone to do things that involve tedious effort. For example, taking surveys may be harder to do versus watching a video. These kinds of people may not feel any motivation to take part in anything, especially answering questions, documenting information, or participating in a survey. Then there are educational delays based on a person's financial situation. This means, a person may come from a low income neighborhood that has criminal activity and people in it that do not wish to learn or cannot afford to attend college. For example, only 80.1% of people aged 25 and over living in zip code 10461 graduated high school. 25.3% attended college and earned a Bachelor's degree or higher. 9.4% earned a graduate degree or professional degree. Although these people have the potential intelligence and ability to do well in an educational setting, they are unable to due to their financial circumstances.

Some of these circumstances stem from unemployment and commute time. Going back to the 25 and over group that reside in area code 10461, 12.6% are unemployed and average commute times for those working and going to school are around 37.5 minutes....

This means they have to travel further in order to get suitable employment or attend classes. Although the average commute time does not amount to hours, it may still generate lack of motivation in those that have to take as long or longer commutes in terms of finishing and earning degrees and working.
Differences and similarities in socioeconomic status and ethnicity impact patient physician relationships, communication, delivery of care, and perceptions of bias therefore, decrease responses rates and overall scores. Going back to the educational stats, 80.1% of the 25 and older population in 10461 earned a high school diploma while 19.9% did not. That means 19.9% of the population in 10461 aged 25 and over could be illiterate or lack the mental faculties to interpret written data, enough so that they are unable to complete surveys. This could also mean they are from a recently immigrated group that cannot speak English, creating communication barriers.

While this does not occur to all people living in low-income neighborhoods, it does occur often. Again, this operates on the principle that hospitals likely draw in patient populations that are reflective of surrounding environment. Differences and similarities in socioeconomic status…

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While this does not occur to all people living in low-income neighborhoods, it does occur often. Again, this operates on the principle that hospitals likely draw in patient populations that are reflective of surrounding environment. Differences and similarities in socioeconomic status and ethnicity impact patient physician relationships, communication, delivery of care, and perceptions of bias therefore decrease responses rates and overall scores. Patients may not feel motivated to communicate or assess their delivery of care due to language barriers or inability to understand what information is written down.

While it has been a moral obligation for medical facilities to give high quality service to patients, the tying of reimbursements to the HCAHPS scores means making it a priority. Through the survey, patients in hospitals around the country use 27 categories to rate the experience of their stay in these facilities using several parameters like communication effectiveness between medical staff, pain management, sanitation and levels of quietness (Letournea, 2014). The payments to hospitals in any given financial year is pegged on the resulting scores.

Hospitals can gain or lose up to 1.5% of Medicare payments assigned to them in the 2015 fiscal year (Letournea, 2014). Increasingly, CMS has been tightening the belt. In the next few years there will be major changes, like a potential surge to 2% of the dollars being at stake by the 2017 fiscal year (Letournea, 2014). With the increasing amount of money at stake, the facilities are seeking more effective strategies to better the experience of their patients and also improve the score they get on HCAHPS.
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