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Patient satisfaction surveys: Tools that can improve your practice and income

Issue: August 2008

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Historically, patient satisfaction information has been collected by physician practices in an ad-hoc, fragmented fashion. Forward-thinking clinicians have surveyed their patients and realized how patient feedback serves to validate and promote their practice. Today, pay-for-performance is around the corner and physicians will be held more accountable for patient satisfaction measurement to receive higher reimbursement from Medicare and health plans. Medicare’s Agency for Healthcare Research and Quality has developed the Clinician and Group Practice CAHPS (Consumer Assessment of Healthcare Provider Systems) survey which is intended to standardize the measurements used to evaluate the patient experience. Centers for Medicare & Medicaid Services (CMS) estimates that each survey will cost $8 to administer. Thus finding a way to capture patient feedback quickly and cost-effectively becomes a priority.

We have asked a panel of orthopedic practice administrators who are primarily using e-mailed patient satisfaction surveys to participate in the following Round Table discussion. These administrators are measuring patient experience for a variety of reasons related to quality improvement, improved communication both internally and externally, marketing service excellence to patients and referral physicians, and staff empowerment. The data collection efforts these practices use will prepare them for pay-for-performance in the future, but more importantly, allow them to respond to patient needs and deliver more patient centric care today.

I hope you find their responses to my questions both informative and useful.

Patricia Riskind
Moderator

Patricia Riskind: Why does your practice measure patient experience/satisfaction?

Ann Bresnen: As an IPA (Independent Physicians Association) consisting of five independent orthopedic practices in the Chicagoland market, we have developed our clinical integration program with a focus on surgical outcomes. Having patient feedback is an integral part in measuring best practice and outcomes. Having instituted all of the CMS orthopedic Physician Quality Reporting Initiative (PQRI) measures, we feel that it is only a matter of time before Medicare adopts patient satisfaction regulations and our active participation at this point puts us ahead of the curve and ready when implemented by CMS.

Paul Kats: We believe that if you don’t measure it, you can’t improve it. The healthcare market is extremely competitive and we need to distinguish ourselves from the competition.

Our goal is to never stop trying to improve the product and services we give the patients.

Tom Laymon: Our mission is “Excellence in Care and Service, One Patient at a Time” and it indicates how important service is to our organization. We needed a process to tell us how successful we are at achieving this goal. Implementing a real-time patient satisfaction survey tool is a great way to obtain this information from our patients with the intent to drive real change in our service and care levels.

Dennis Viellieu: We wanted real-time and ongoing feedback from our patients on how well we were meeting their needs both from a quality of care standpoint as well as a physical plant and administrative perspective. Being a larger organization/practice with multiple sites it gets more difficult to stay connected with how successful you are in addressing your patients’ needs and issues — we thought this was a way to do that.

Riskind: What methods are you using to collect feedback from patients and why did you choose that approach?

Bresnen: As the IPA, we were already collecting claims data electronically from the practices through their varied practice management systems. We implemented collection of email addresses. Adding e-mail to the demographic fields captured, and thus easily “uploaded,” e-mail address along with the clinical information, eg, the surgeries performed by each practice from their practice management systems. Our survey vendor receives the uploaded file and automatically sends the post-operative surgical survey 6 weeks from the surgery date, giving patients time to recover and effectively evaluate their surgical experience.

Kats: We collect patient e-mail addresses and send them electronic surveys. We are currently using electronic medical records and thus e-mailing the surveys fits in with our goal of becoming a paperless organization. In addition, some quarters we send our surveys to just our new patients and other quarters to our returning patients. This allows us to track the experience for different types of patients.

Laymon: We selected an e-mail approach to collect responses for the patient satisfaction survey. Those patients willing to participate in the survey provide us their e-mail and within 24-hours they receive a request for feedback regarding their recent visit. As another option for our patients who have feedback to provide, but may not have had a recent appointment with us, we have implemented a patient advocate line that can be accessed 24 hours-a-day by patients. This telephone line serves as an additional method for feedback collection that can be used at a time convenient for the patient.

Viellieu: People always have the ability to speak directly with their physician or on-site office manager. For our more formal collection, we e-mail them a survey after their visit. We felt that this was the least intrusive and most effective way to solicit feedback from our patients. We felt that people really don’t like to be contacted by phone for surveys and with email they can very easily respond or just delete the e-mail. We felt paper surveys, via mail or on-site, were too unwieldy and also more susceptible to manipulation.

Riskind: How are you using the patient satisfaction information you collect?

Bresnen: Our clinical integration committee, consisting of physician peers from all of our practices, use the patient survey results to analyze and evaluate best practice measures for improvement of performance.

Kats: We have established a customer service committee of managers and rank-and-file employees that reviews the data monthly and develops action plans to make necessary changes in the practice.

Laymon: We have just gotten all of our physician offices live with the application, so we are still early in the data capture process. We are sharing all comments received with the physicians on a monthly basis. The actual scores are shared with the physicians as they reach the threshold required to receive them. We also use the feedback for staff recognition and for service process improvement.

Viellieu: We respond directly and as quickly as possible to those who have a specific issue and want us to contact them. We also review the responses weekly with our operations team to make any necessary operational changes. We review the information quarterly with the physicians so they understand how they are performing vs. their colleagues, the practice or whatever external benchmarks we have available. We have also incorporated the results into the incentive program for clinic staff.

Riskind: Please give specific examples of the impact of using the patient experience information.

Bresnen: The current method of distribution and collection of the surveys has streamlined the process of measuring across 54 locations in a way that paper surveys would never have accomplished. It has cut staff labor costs and increased efficiency and accuracy with excellent results to validate performance measures. We achieve an average of 30% response rates with some sites as high as 40%.

Kats: We started a program called “Customer Service Stars” and any time a patient tells us one of our employees did a great job, we put their name with the comment in our bi-monthly employee newsletter. It’s a constant reminder to the rest of the staff, and employees love to see their name in the newsletter.

We changed our mission/vision statement to “Extraordinary Service. Extraordinary Outcomes.” This is something the employees can relate to and is easy to remember.

Per remarks from our survey, we decided we needed to make the waiting rooms more patient-friendly and are in the process of changing the look and amenities.

Laymon: As mentioned earlier, we are still relatively early in that data capture and implementation process. However, we have received very positive responses from patients regarding our interest in their feedback. They have expressed great satisfaction with just being asked to participate in a survey.

We survey all patients, every visit and are achieving an organization-wide response rate of 29%. So not only are the patients pleased to be asked to participate, they are actually taking the time to provide the feedback that will enable us to make necessary service improvements.

Viellieu: I think the biggest impact to date for our group has been that the e-mail process has opened up the channel of communicating electronically with patients. We quickly found out that we were not very effective about getting and entering a correct e-mail address for our patients who have them. We are now much better at that process and it has positioned us to work electronically with our patients in the future, and help us provide them with care much more effectively and efficiently on many different fronts.

For more information:

• Ann Bresnen can be reached at Midwest Orthopaedic Network 111 North Canal St., Suite 915, Chicago, IL 60606; 312-906-9900: e-mail: abresnen@midwestorthonet.net.
• Paul Kats can be reached at M&M Orthopaedics Ltd, 4115 Fairview Ave., Downers Grove, IL 60515; 630-968-1881; e-mail: pkats@mmortho.com.
• Tom Laymon can be reached at OrthoCarolina 1915 Randolph Road, Charlotte, NC 28207; 704-323-2000; e-mail: tom.laymon@orthocarolina.com.
• Patricia Riskind can be reached at PatientImpact LLC, 1560 Sherman Ave., Suite 305, Evanston, IL 60201; 847-853-4314; e-mail: priskind@patientimpact.com.
• Dennis Viellieu can be reached at Midwest Orthopaedics at Rush, 1 Westbrook Corporate Center, Suite 240, Westchester, IL 60154; 708-236-2600; e-mail: dviellieu@rushortho.com.

Reference:

• Riskind P, Viellieu D, Kats P, Bresnan A. Satisfied to the bone. Paper #34 presented at The American Association of Orthopaedic Executives Annual Conference. April 13-16, 2008. Charlotte, N.C.