Low CAHPS survey responses pose a challenge for nephrologists, providers

ORLANDO, Fla. — Nephrologists need to take an active role in improving the response rate to surveys sent to patients asking them about the quality of care they receive, particularly because the results are being used by CMS as a factor to determine shared savings in pay-for-performance models like the Comprehensive ESRD Care Demonstration.

Speaking at the Renal Physicians Association Annual Meeting here, Lorien S. Dalrymple, MD, MPH, said use of the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) Survey provides opportunities for kidney care professionals to learn about the quality of the care they deliver to patients.

Lorien S. Dalrymple

“This will tell you more than looking at vascular access measures or KtV,” she said. “It helps you understand the patient experience of in-center hemodialysis care with information that is distinct from other quality measures.”

The ICH-CAHPS will be the only quality measure shared by the Quality Incentive Program (QIP), the CEC model and the Star Rating System in 2018, and the survey remains the only patient-reported measure currently included in ESRD payment models and public reporting.

For nephrologists, one-third of the survey includes questions specifically about their performance. That makes it important for them to encourage patients to complete the survey, said Dalrymple, who is vice president of epidemiology and research at Fresenius Medical Care.

Increasing the number of responses from patients is key for nephrologists and dialysis providers who received shared savings in the CEC model. In the demonstration, CMS is looking at ICH-CAPHS survey results at a lower sampling rate – 11 responses in a clinic – vs. 30 in the QIP. Therefore, more facilities would be evaluated in the CEC demonstration based on the survey results than those that are part of the QIP.

“It is entirely possible that your performance will not be looked at in the QIP or Star Ratings System, but will be looked at in the CEC model because it will roll up to an ESCO-level measure,” she said.

For the survey, which must be conducted twice a year, CMS selects a sample of patients served by the facility and distributes the samples to each facility’s survey vendor, which must be approved and trained by CMS. The sixth of the survey was released this past February.

However, there are challenges to getting patients interested in responding to the survey, Dalrymple said. She noted the following:

As the kidney care team cannot issue the surveys or help patients complete it, independent vendors are solely responsible for getting patients to complete it.

The survey itself is long and its 62 questions may prove tiresome for the patient to complete.

It must be administered twice a year to patients as part of the QIP requirement, but there is no guarantee the responders are unique. “These may not be 30 independent responses each time the survey is returned,” Dalrymple said. “Are these results really representative of the patient care experience?”

Other than specific questions about care from nephrologists, other care-related questions in the survey do not delineate between nurses, social workers, dietitians and other staff members.

Certain patient populations, like patients on home dialysis and pediatric patients, are excluded from the survey process.

The vendors can call patients to follow up on survey returns, but “Do patients want to answer the phone when a stranger calls?” Dalrymple asked. Surveys can be re-sent to patients as well, but that does not always increase responses, she added.

“Low responses rates continued to be a challenge,” she said. – by Mark E. Neumann

References:

Dalrymple LS. Understanding CAHPS and implications for nephrology. Presented at: Renal Physicians Association Annual Meeting; March 15-18, 2018; Orlando, Fla.

https://ichcahps.org/SurveyandProtocols.aspx

Disclosure: Dalrymple reports no relevant financial disclosures.