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© Planetree 2013
Patient-Centered Strategies for HCAHPS Improvement
Presenter: Michael Lepore, PhD, Director, Research , Quality and Evaluation, Planetree
May 8, 2013
© Planetree 2013
Overview
• HCAHPS Basics
• Patient Experience as a Healthcare Priority
• From Improving HCAHPS Scores to Changing the Culture of Care Delivery
• Patient-Centered Strategies for HCAHPS Improvement
© Planetree 2013
HCAHPS 101 Hospital Consumer Assessment of Healthcare Providers and Systems
© Planetree 2013
HCAHPS 101
• A tool that asks patients about their hospital experiences
• A method for collecting standardized patient experience data
• A method for adjusting data for equitable comparisons and benchmarking
• A mechanism for publicly reporting results
• Incentives for using to improve hospital quality of care
© Planetree 2013
• Dec. 2012 publicly reported scores are based on more than 2.9 million completed surveys from patients at 3,892 hospitals
• Every day more than 7,900 patients complete the HCAHPS survey
© Planetree 2013
Improving the patient experience is a priority
© Planetree 2013
HCAHPS and the Quality Connection
“HCAHPS performance is more predictive of readmission rates than the objective clinical performance measures often used to assess the quality of hospital care.”
Boulding et al. in American Journal of Managed Care, 2011
“Two overall measures of hospital performance, the overall rating of the hospital and willingness to recommend the hospital, had strong relationships with better technical performance in processes of care related to pneumonia, CHF, myocardial infarction, and for surgical care.”
Isaac et al. in Health Services Research, 2010
© Planetree 2013
Elevating the importance of patient experience measures
Value-Based Purchasing:
Transition from pay for reporting to pay for performance
• Points earned for:
– Achievement
– Improvement
– Consistency (HCAHPS)
© Planetree 2013
2013 Value Based Purchasing Domains
• AMI
• Heart Failure
• Pneumonia
• Surgical Care Improvement
• Healthcare Associated Infections
Clinical Process of Care Domain
(12 measures)
• HCAHPS measures
• 7 composites & 1 global measure
• Does not include Likelihood to Recommend
• Quiet at Night and Cleanliness rolled into one composite
Patient Experience of Care Domain
(8 measures)
70%
30%
© Planetree 2013
Proposed 2014 Value Based Purchasing Domains
25% Outcomes
45% Clinical Process of Care
30% Patient Experience of Care
© Planetree 2013
HCAHPS Performance 30% of Total
National Median VBP Score 54
Score Needed to Maximize Medicare Reimbursements Under VBP
70
National Median Score on Clinical Measures
64
Score on Clinical Measures Needed to Maximize Reimbursement
81
National Median HCAHPS Score 21
HCAHPS Score Needed to Maximize Medicare Reimbursements
61
The heart of the matter –
relationships and communication.
“I find that if the doctors would just talk in my terms
instead of these long words, that would help. I
am not a doctor; these words don’t mean nothing
to me.”
-
© Planetree 2012 © Planetree 2012
A Consistent Finding: It’s All About Culture
• High performing sites credited their success not to specific practices, but to a well-established culture of patient-centered care
• High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement
© Planetree 2012
Need list of members
From Improving HCAHPS Scores to Changing Health Care Cultures: Planetree
© Planetree 2012 © Planetree 2012
Individual
Team
Industry Advocate
Solution Provider
Standard
Setter
Who is Planetree?
© Planetree 2013
Advocating for what patients and caregivers need and want
Compassionate Human Interactions
Access to Meaningful Information
Support & Participation of Family, Friends
Healing Environment
Support for body, mind & spirit
Arts and Entertainment
Spirituality
Caring Touch
Integrative Therapies
Healthy Food and Nutrition
© Planetree 2013
Planetree Model Components
HCAHPS Categories
Compassionate Human Interactions
Communication with Nurses Communication with Physicians Responsiveness Pain Management Care Transitions Overall Satisfaction and Likelihood to Recommend
Access to Meaningful Information
Communication with Nurses Communication with Physicians Communication about Medications Care Transitions Discharge Instructions
Support and Participation of Family Responsiveness Discharge Instructions
Healing Environment Cleanliness Quiet at Night
Support for Body, Mind and Spirit
Responsiveness Pain Management Quiet at Night Overall Satisfaction and Likelihood to Recommend
Making the Connection
© Planetree 2013
1) Partner with patients.
2) Create a physical environment that supports your culture.
3) Make data meaningful to staff.
4) Look beyond the hospital setting.
5) Put compassion first.
Patient-Centered Strategies for HCAHPS Improvement
1. Partner with Patients and Families
Patient Pathways
Shared Medical Records
77.8%
69%
50%
60%
70%
80%
90%
Yes No
*Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)
Were you told you could read your medical chart?
Ver
y sa
tisf
ied
wit
h t
hei
r o
vera
ll h
osp
ital
exp
erie
nce
?
Patients who are told they could read their medical chart are more likely to be very satisfied with their overall hospital experience
Impact of Shared Medical Record on Overall Patient Satisfaction with Care
© Planetree 2013
“Reviewing the chart with someone put me at ease.”
Bedside shift report drives patient satisfaction
82
84
86
88
90
92
94
96
Nurses treat youwith
courtesy/respect
Nurses attitudetoward requests
Attention tospecial/personal
needs
Nurses kept youinfromed
Staff include youin decision re:
treatment
Staff workedtogether to care
for you
6 months prior to implementation of bedside report
6 months after implmentation of bedside report
Effects of bedside shift change at a Planetree Designated Hospital
Partnering with Patients…Beyond the Bedside
• Invite patients to serve on hospital committees and HCAHPS improvement task forces
• Invite board members to round on patients prior to every board meeting
• Invite a patient to share his or her story (what went well, what didn’t go well) to kick off every board meeting
2. Create a physical environment that supports your culture
“Why is the hospital not as humanely practical in aesthetic effect as it tries to be in physical support?”
Frank Lloyd Wright
© Planetree 2013
Poor Patient Experience = Post-Hospital Syndrome
CONTRIBUTING FACTORS:
• sleep deprivation
• disruption of normal circadian rhythms
• poor nourishment
• poorly controlled pain and discomfort
• medications that can alter cognition and physical function
• deconditioning due to bed rest or inactivity
Krumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013
© Planetree 2013
Assess Your Healing Environment/Reduce Stressors
EMOTIONAL SUPPORT • Family overnight accommodations
SLEEP SUPPORT • Quiet Environment/Sleep Menus
NOURISHMENT • Family Kitchens/Access to Food
CONNECTION TO NATURAL ENVIRONMENT • Healing Gardens and Natural Light
© Planetree 2013
Innovations in the Healing Environment: A Patient-Centered Quiet Campaign
More Evidence
The use of call lights by patients decreased by 40% following implementation of decentralized nursing stations & 24-hour visitation (Charmel, 2003)
3. Make data meaningful to
staff.
But remember, the data are not the point, patient experiences are the point!
-
© Planetree 2013
Making Data Meaningful to Staff
Engage staff (and patients) in the selection of quality measures
Involve staff in performance improvement efforts
Give staff time to participate in improvement efforts
Display data so it is easy to read and standardized
Make staff aware of the data being measured
Discuss in staff meetings
Reinforce with postings and displays
Meredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.
© Planetree 2013
4. Look beyond the hospital setting
© Planetree 2013
New HCAHPS Domain: Care Transitions
Mandatory for patients discharged as of Jan. 2013: • Question 1: The hospital staff took my preferences and those
of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital.
• Question 2: When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
• Question 3: When I left the hospital, I clearly understood the purpose for taking each of my medications.
© Planetree 2013
Patient-Centered Care Transitions
Hospital
Skilled
Facility Home Health
Agency
Physician
Office
Patient
• Same Page Transitions
• Inter-Continuum Collaboratives
• Physician appointments made prior to hospital discharge
• Discharge summary provided to patient and PCP
• Personal Health Records
• Support for family caregivers
© Planetree 2013
5. Put compassion first.
“I felt like I was interrupting them when I asked a question.”
Compassion in Action
VA New Jersey Sleep Menu
Good Samaritan Hospital Patient
Story Board
Physician communication
coaching
Patient Experience training and education for staff- Middle Management Training
“[The doctor]
came in, pulled
up a chair and
said he wanted
to talk…and we
talked on my
terms.”
© Planetree 2013
Criteria can be downloaded at www.planetree.org
A Measureable Framework for PCC Culture Change and HCAHPS Improvement
Planetree Designated Hospitals and HCAHPS performance:
A marker of Quality:
Planetree Designated Hospitals consistently outperform the National Average on HCAHPS since public reporting of scores began.
69
70
71
72
73
74
75
76
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patient's Room and Bathroom Always Kept Clean
Designated Hospital Average National Average
62
63
64
65
66
67
68
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Responsiveness
Designated Hospital Average National Average
Note: The difference is statistically significant (p<0.05).
80
81
82
83
84
85
86
87
88
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patients Given Information About Recovery At Home
Designated Hospital Average National Average
56
57
58
59
60
61
62
63
64
65
66
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Staff Always Explained About Medicines
Designated Hospital Average National Average
75
76
77
78
79
80
81
82
83
84
85
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Doctors Always Communicated Well
Designated Hospital Average National Average
Note: The difference is statistically significant (p<0.05).
74
75
76
77
78
79
80
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Nurses Always Communicated Well
Designated Hospital Average National Average
Note: The difference is statistically significant (p<0.05).
68
69
70
71
72
73
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Pain Was Always Well Controlled
Designated Hospital Average National Average
55
56
57
58
59
60
61
62
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patient's Room Always Kept Quiet At Night
Designated Hospital Average National Average
Note: The difference is statistically significant (p<0.05).
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Percent of Patients Highly Satisfied (Overall Rating 9 or 10)
Designated Hospital Average National Average
Note: The difference is statistically significant (p<0.05).
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Would Definitely Recommend Hospital to Friends and Family
Designated Hospital Average National Average
The Bottom Line on VBP and Designation
A preliminary analysis indicates that, as a group, Patient-Centered Designated Hospitals are poised to receive:
•127% in reimbursement revenue
•$770,000(100% of all withheld monies plus additional revenues)
© Planetree 2012 © Planetree 2012
Resources For Your Journey
Patient-Centered Care Improvement Guide
Patient-Centered Hospital Designation
Criteria
HCAHPS Assessments
© Planetree 2012 © Planetree 2012
Planetree
130 Division Street
Derby, CT 06418
www.planetree.org
203.732.1365
Michael Lepore, PhD
Director of Quality, Research, & Evaluation
Questions