HCAHPS and you: Using experience-based methodology to deliver exceptional care experiences and outcomes

Introduction

This series focuses on new ways of thinking about health care delivery that will position you and your hospital for the challenges ahead. In part two of this 2-part series we show why it is important for you and your hospital to understand Hospital Consumer Assessment of Health care Providers and Systems (HCAHPS, pronounced “H-caps”) surveys and scores and how you can use experience-based methodologies that focus on patient and family care experiences to develop Focused Care Centers and Accountable Care Organizations (ACOs).

– Anthony M. DiGioia III, MD; Kevin J. Bozic, MD, MBA; and Regina Herzlinger, PhD

Anthony M. DiGioia III

Kevin J. Bozic

Regina Herzlinger

Care-experience-based methodologies are the new performance improvement tools that also encompass process improvement that will help surgeons and hospitals provide a systematic approach to delivering exceptional care experiences. Experience-based design tools are “low tech” and inexpensive, but can dramatically change the way care is delivered and result in value added improvements from the perspective of patients and families. In addition, by focusing on performance and care experiences, you will also improve outcomes, safety, quality and efficiencies all at once. One care-experience-based tool that we will describe is called the Patient and Family Centered Care Methodology and Practice (PFCC M/P).

Why be concerned?

Today, standardized national quality measures called HCAHPS, are already being used to evaluate performance for hospitals. HCAHPS are a set of 27 standardized questions developed and validated by the Centers for Medicare & Medicaid Services (CMS). HCAHPS are used to gather information about the inpatient care experience allowing patients, payers and providers an objective evaluation and comparison of care being delivered by physicians, nurses and hospitals. The goals of HCAHPS are:

• to produce data about patients’ perspectives of care through a method that allows for objective, valid comparisons across hospitals locally, regionally and nationally on topics that are important to consumers;
• to facilitate public reporting of survey results that will create new incentives for hospitals to improve quality of care; and
• to increase accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.

The survey is administered to a random sample of adult patients across medical conditions (not restricted to Medicare beneficiaries) between 48 hours and 6 weeks after discharge from the hospital. Hospitals can either use an approved survey vendor, or collect their own HCAHPS data (if approved by CMS). The survey can be implemented via four different modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition. To achieve the goal of fair comparisons across all hospitals that participate in HCAHPS, survey results are adjusted for mode of survey administration, characteristics of patients in participating hospitals, and differences between participating and non-participating patients. Hospitals can use the HCAHPS survey alone, or include additional questions after core items. Hospitals must survey patients throughout each month of the year.

Since March 2008, patients and their families have been able to view performance scores on a public website (www.hospitalcompare.hhs.gov). This allows anyone to directly compare scores between hospitals when searching for care providers. More importantly, in 2013, it is expected that CMS Value Based Purchasing Program will transition from “Pay-for-Reporting” to “Pay-for-Performance” and Medicare reimbursements will be tied to HCAHPS performance scores, with up to 2% of those dollars at stake.

Why use HCAHPS?

HCAHPS is a standardized survey that captures patients’ perspectives on their hospital care for the purpose of providing the public with comparable information on quality and more importantly, their care experiences. HCAHPS is a validated tool that goes well beyond patient satisfaction and is part of a public/private partnership dedicated to transparency. HCAHPS provides consumers, health care professionals and individual hospitals with standardized and comparable information on how patients viewed their overall care experience. In addition to gaining insights into their own care processes, hospitals and physicians will be able to compare themselves to other hospitals and the industry as a whole on exactly the same indicators. This information can then be used to spur hospitals’ care improvement programs and will also allow hospitals to track changes in patient perspectives on their care over time.

Who benefits from HCAHPS?

Top performing health care providers and hospitals and the greatest improving health care providers will be financially rewarded. Hospitals that choose not to participate or who do not meet minimal HCAHPS performance standards could see a reduction of up to 2% of their Medicare reimbursements.

So, delivering exceptional care experiences is going to be important to you and your hospital in the coming years. To be competitive, care-experience-based designs require new forms of collaboration and team building between physicians and other health care providers, hospitals, patients and their families. The problem has been that we have not had the performance improvement tools to help all caregivers and hospitals to go from the current state to the ideal care experience; but now we do with the PFCC M/P.

As an experience-based design tool, PFCC M/P is the performance improvement tool designed specifically for health care and goes beyond process improvement. Care-experience-based methodologies can transform health care delivery system by focusing, most simply, on what is right and value added from the perspective of the patient and family. By continually examining performance and experience from the patient and family perspective, the PFCC M/P impels a sense of urgency to drive organizational change and provides the tools to sustain transformation in any hospital, clinic, department or organization. The PFCC M/P is also simple to learn and intuitive for caregivers to earn and most importantly, engages them as well as patients and families to develop the care delivery systems for the future.

This won’t cost you a cent

You can refocus existing resources to develop a “hospital within a hospital.” By bringing together all of the people and processes with the singular focus on the care experience of patients and their families, you can create high performance care teams and will lead to Focused Care Centers (FCC) and set the stage for an ACO which we discussed in part one of this series.

We have developed several care-experience-based FCCS within the University of Pittsburgh Medical Center system using the PFCC M/P. As detailed in part one of this series, the Hip and Knee Arthritis Care Center at Magee-Women’s Hospital is but one example. Others include, level I trauma care, women’s oncology care, the surgical care experience and bariatrics care among several others. PFCC M/P treats patients and families through a full cycle of care, as defined from the patient’s perspective, and will result in better communications and transitions of care for any care experience. We have shown that we can positively impact patients’ and families’ experiences as well as enhance their outcomes, improve safety and efficiencies and reduce costs, and improve HCAHPS scores as one end result.

Most importantly, no one can ever go wrong by focusing on the needs of their patients and their families through a full cycle of their care. So not only will you be able to deliver exceptional care experiences, but you will also deliver better outcomes, improve quality and safety and improve efficiencies all by focusing on care as seen through the eyes of patients and families.

Anthony M. DiGioia III, MD, is the editor of Emerging Technologies & Innovation. He can be reached at Renaissance Orthopaedics, PC, and Pittsburgh, Pennsylvania Innovation Center, Magee-Women’s Hospital of UPMC, Pittsburgh, Pennsylvania. He is a shareholder in Blue Belt Technologies.

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