The Quest for “Always”

Nursing Excellence ConferenceApril 19,2013

Objectives Discuss the History of HCAHPS

Understand the Eight (8) Patient Experience of Care Dimensions

Review Current South Carolina Performance

Relate HCAHPS to the Value Based Purchasing initiative

HCAHPS

Hospital Consumer Assessment of Healthcare Providers and Systems

Other surveys: CAHPS® HHCAHPS CG-CAHPS

Overview of HCAHPS Developed by the Agency for Healthcare Research and Quality

(AHRQ) for the Centers for Medicare and Medicaid Services (CMS)

National, standardized patient perception study related to hospital care experience

Designed to: Measure compliance with evidence based practices Provide consumers with information regarding patient perspectives

on quality of care (not patient satisfaction) Allow comparisons to be made between healthcare facilities Create a metric that can be used for performance incentives (Pay-

for-Performance) Increase overall accountability

2002 200620102005 2008

CMS partners with AHRQ to develop HCAHPS survey

October 2006, CMS implements HCAHPS survey

HCAHPS survey endorsed by National Quality Forum

Value Based Purchasing

Incentive Payments

Inpatient Perspective Payment System (IPPS)

Patient Protection and Affordable Care

HCAHPS Timeline

2012

First public reporting on HCAHPS

Reimbursement Dollars are at

Risk $$$

HCAHPS Survey Process Survey design

20 experience of care questions 2 Overall Global ratings 7 Demographic questions 3 Care transition questions

Random Sampling of eligible discharges 300 completed over a 12 month period (minimum) No interviewing or distributing surveys while patients

are still in hospital Four (4) Survey modes

Mail Telephone Mail with telephone follow-up Active Interactive Voice Response (IVR)

HCAHPS Survey Process

Inclusions for survey Adult patients (18 years and older) Medical, Surgical or Maternity care Overnight stay or longer Alive at discharge

Exclusions from survey Pediatric patients Psychiatric patients Hospice discharges Prisoners or law enforcement patients Patients discharged to nursing homes and skilled

nursing facilities No Publicity patients

HCAHPS Experience of Care Dimensions

Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medications Hospital Environment Discharge Information Overall Hospital Ratings

HCAHPS Dimensions

HCAHPS Questions

Communication with Nurses * Nurse Courteous and Respectful Nurse Listens Carefully Nurse Explains Things

Communication with Doctors Doctor Courteous and Respectful Doctor Listens Carefully Doctor Explains Things

Responsiveness of Hospital Staff * Assistance to Bathroom Response to Call Button

Pain Management * Pain Well Controlled Help With Pain

Communication About Medicines * Explain New Medications Explain New Medication Side Effects

Hospital Environment Cleanliness of room Cleanliness of bathroom

Discharge Information * Discharge Help Discharge Symptoms

Overall Hospital Ratings Overall Hospital Ratings Willingness to Recommend

* Designates Patient Care Dimensions related to the Magnet Sources of Evidence

AlwaysUsually

Sometimes

Never

HCAHPS Primary Rating Scale

“Always” is the only score that counts!!

HCAHPS Overall Ratings

Overall Rating of the Hospital Using any number from 0 to 10, where 0 is the worst

hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay? (Percent 9 & 10 Ratings)

Willingness to Recommend Would you recommend this hospital to your friends and

family? Definitely no Probably no Probably yes √ Definitely yes

So How Are We Doing????

HCAHPS PerformanceSouth Carolina Results

"Percent Always"April 2011 - March 2012

66

68

68

72

73

80

84

0 10 20 30 40 50 60 70 80 90

Staff explanations about medications?

Did patients receive help quickly fromhospital staff?

Was the area around patients roomskept quiet at night?

Were patients' pain well controlled?

Were the patients' rooms andbathrooms kept clean?

Nurses Communicate well with patients

Doctors communicate well with patients

Percent "Always" Response

Communication with Nurses 1. During this hospital stay, how often did nurses treat you with courtesy and respect?

1Never

2Sometimes

3Usually

4√Always

2. During this hospital stay, how often did nurses listen carefully to you?

1Never

2Sometimes

3Usually

4√Always

3. During this hospital stay, how often did nurses explain things in a way you could understand?

1Never

2Sometimes

3Usually

4√Always

HCAHPS PerformanceSouth Carolina Compared to National Average

April 2011 - March 2012

63

66

60

70

73

78

81

66

68

68

72

73

80

84

0 10 20 30 40 50 60 70 80 90

Staff explanations about medications?

Did patients receive help quickly fromhospital staff?

Was the area around patients roomskept quiet at night?

Were patients' pain well controlled?

Were the patients' rooms andbathrooms kept clean?

Nurses Communicate well with patients

Doctors communicate well with patients

Percent "Always" Response

National Average South Carolina

Communication about Medications15. During this hospital stay, were you given any medicine that you had not taken before?

1Yes

2No If No, Go to Question 18

16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

1Never

2Sometimes

3Usually

4√Always

17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

1Never

2Sometimes

3Usually

4√Always

Screening Question….

23. During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.

1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree

24. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree

25. When I left the hospital, I clearly understood the purpose for taking each of my medications.

1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree 5 I was not given any medication when I left the hospital

UNDERSTANDING YOUR CARE WHEN YOU LEFT THE HOSPITAL --- New Questions

Overall Ratings

HCAHPS PerformanceSouth Carolina Results

April 2011 - March 2012

70

69

71

71

0 10 20 30 40 50 60 70 80

Willingness torecommend

Overall Rating

National Average South Carolina

Percent of Patients Giving 9 or 10 Ratings

Definitely Would Recommend

The Key is Improvement…..

The database is moving……

Without continual improvement we will fall behind!!

South Carolina = 69% 9 & 10 ratingsSource: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013

HCAHPS SummaryOverall Rating Performance

April 2010 - March 2011

1 1 1

3

2

7

4

2

6 6

4

3

2

5

3

0 00

1

2

3

4

5

6

7

8

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76

Percent 9 & 10 Ratings

Nu

mb

er o

f S

tate

s

34% of States have a 70% or higher 9 & 10 ratings

South Carolina = 71% 9 & 10 ratingsSource: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013

HCAHPS SummaryOverall Rating Performance

April 2011- March 2012

0

1

0

2

0

4 4 4

5

7

4

5

3

2

7

2

00

1

2

3

4

5

6

7

8

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76

Percent 9 & 10 Ratings

Nu

mb

er o

f S

tate

s

46% of States have a 70% or higher 9 & 10 ratings

So Why is HCAHPS so Important??

Value Based Purchasing

Value Based Purchasing Value Based Purchasing (VBP) is a CMS program that

rewards organizations based upon the quality of care they provide – not the volume of services they provide

Established in 2010 with the passing of the Affordable Care Act

Value Based Purchasing is designed to improve clinical outcomes and the patient experience of care during hospitalizations

Pay-for-Performance Performance Periods Reimbursement dollars at risk

Value Based Purchasing –Performance Periods

Fiscal Year 2013 = 1.0% at risk Performance Period ( 7/1/2011 – 3/31/2012)

Fiscal Year 2014 = 1.25% at risk Performance Period (4/1/2012- 12/31/2012)

Fiscal Year 2015 = 1.5% at risk Performance Period (1/1/13- 12/31/2013)

Fiscal Year 2016 = 1.75% at risk

Fiscal Year 2017 = 2.0% at risk

HCAHPS and Value Based Purchasing FY 2013 --1.0% at risk

HCAHPS (30%) Clinical Care Processes (70%)

FY 2014-- 1.25% at risk HCAHPS (30%) Clinical Care Processes (45%) Outcomes (25%)

FY 2015-- 1.5% at risk HCAHPS (30%) Clinical Care Processes (20%) Outcomes (30%) Efficiency (20%)

Scoring Achievement points Improvement points

Value Based Purchasing – Patient Experience of Care Domain Summary (Report Example)

Database

Dimension Score is basedon the greater of

Improvement or achievementpoints

Value Based Purchasing– Key Points

We must understand that reimbursement dollars are at risk Budget neutral program

Our current performance impacts future reimbursement

All organizations are working to improve their performance

So What Can You Do?

Understand your own organizational HCAHPS scores http://www.medicare.gov/hospitalcompare/

Identify areas of strengths and opportunities Prioritize areas of opportunity Utilize evidence based tools (i.e. AIDET, Rounding,

etc)

Communicate results at all levels of the organization – “Connect the Dots” for all staff

Celebrate and share your successes

Final Thoughts Pay-for-Performance is here to stay

Expect more transparency as it relates to Value Based Purchasing performance

Improvement is not optional

HCAHPS and Value Based Purchasing are organizational objectives

The Quest for “Always” starts with each one of us

The Quest for “Always”

Questions

Sources/Links

http://www.theberylinstitute.org/?page=IMPX_VIDEO

http://www.hcahpsonline.org/

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/HospVBPNPC100412.pdf