1. The Hospital CAHPS Program Presented by Maureen Parrish

2. Overview Understanding HCAHPS Overview of the survey tool and administration guidelines Public reporting of HCAHPS data The HVBP Program and it’s effect on your hospital’s reimbursement

3. Understanding HCAHPS What is HACHPS? Hospital Consumer Assessment of Healthcare Providers & Services (HCAHPS or Hospital CAHPS) is a standardized patient experience survey system with hospital specific quality indicators that was developed out of a partnership between the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research & Quality (AHRQ).

4. Understanding HCAHPS Hospital Patient Satisfaction Surveys before HCAHPS Hospitals chose their own: –Survey method –Benchmarks –Indicators –Response scoring Most hospitals only reported internally.

5. Understanding HCAHPS Evolution of HCAHPS 2002 – CMS partners with AHRQ to develop and test the survey which included a 3 state test pilot and a CMS held forum to allow the public feedback. May 2005 – HCAHPS was endorsed by the National Quality Forum (NQF). December 2005 - The federal Office of Management and Budget gave its final approval for the national implementation of HCAHPS for public reporting purposes. October 2006 - CMS implemented the HCAHPS Survey March 2008 - The first public reporting of HCAHPS methodology and the results are in the public domain.

6. Understanding HCAHPS 3 Goals of HCAHPS Produce comparable data from the patient's perspective on care that allows “apples to apples” comparison between hospitals on subjects that are most important to patients. Encourage improvement efforts of hospitals through public reporting. Promote patient accountability by increasing transparency between hospitals and patients.

7. HCAHPS Survey Tool Survey Sections 10 original measures –2 global questions  Rate hospital 0-10  Recommend the hospital –6 summary areas  Communication with nurses  Responsiveness of hospital staff  Communication with doctors  Pain management  Communication about medications  Discharge information –2 individual questions  Cleanliness of hospital environment  Quietness of hospital environment NEW in 2013: Transitions of Care –Currently only in trial and is not required

8. Survey Administration Patient Sampling Recently discharged patients are required to receive a survey between 48 hrs and 6 weeks of discharge. Most surveys are sent within 2 weeks of discharge and are typically returned within 6 weeks of discharge. Hospitals must sample patient during each month of the year. Hospitals may choose their method CMS approved survey vendor vs. hospital administered Telephonic vs. paper Patient Eligibility - Patients admitted in the medical, surgical and maternity care service lines are eligible for the survey; the survey is not restricted to Medicare beneficiaries.

9. Survey Administration Formatting Hospitals may use the HCAHPS Survey alone, or include additional questions after the core HCAHPS items. Hospitals may not change the HCAHPS core questions content.

10. Public Reporting of HCAHPS Data CMS Publicly reported results are based on four consecutive quarters of patient surveys and published by CMS on the Hospital Compare Web site (www.hospitalcompare.hhs.gov).www.hospitalcompare.hhs.gov Each hospital is required to have at least 300 returned surveys in consecutive 4 month period. Scores are updated 4 times a year The first public reporting of HCAHPS results in March 2008 included 2,521 hospitals and 1.1 million completed surveys. By the Spring 2012 public reporting entailed 3,851 hospitals and 2.8 million completed surveys.

11. Public Reporting of HCAHPS Data Other public reporting resources Leap Frog Health Grades Individual Hospital Websites

12. HVBP Program What is the HVBP Program? Hospital Value-Based Purchasing (HVBP) Program is a CMS program that rewards hospitals that provide high quality care for their patients by basing each hospital’s reimbursement for inpatient acute care services based on care quality, not just the quantity of the services they provide. It includes clinical quality and Patient Experience Indicators. A pay-for-performance approach to the payment system that accounts for the largest share of Medicare spending, affecting payment for inpatient stays in over 3,500 hospitals across the country.

13. HVBP Program Excellent Customer Service Increased patient compliance High patient scores Positive patient perception Positive clinical outcome

14. HVBP Program Government Incentive to hospitals Enactment of the Deficit Reduction Act of 2005 –Since July of 2007 Inpatient Prospective Payment System (IPPS) requires eligible hospitals to participate and submit HCAHPS data in order to receive their annual reimbursement. –IPPS Hospitals that fail to publicly report the required quality measures may have their reimbursement reduced by 2.0 percentage points. –Non-IPPS hospitals, such as Critical Access Hospitals, may voluntarily participate in HCAHPS. Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), which specifically included HCAHPS performance in the calculation of the value-based incentive payment in the Hospital Value- Based Purchasing program, beginning with discharges in October 2012

15. HVBP Program Scoring Methodology Patient Experience accounts for 30% of the hospital’s overall HVBP score. Each Patient Experience measure is scored for Achievement Points and Improvement Points. The score that is awarded to a hospital for each measure is the higher of these two scores. –Achievement Points: are awarded by comparing an individual hospital’s rates during the performance period with all hospitals’ rates from the baseline period. –Improvement Points: are awarded by comparing a hospital’s rates during the performance period to that same hospital’s rates from the baseline period. –Consistency Points: are awarded on top of the achievement or improvement points (whichever is greater for each measure).

16. The HCAHPS Effect Patients will be better informed about their healthcare options. Hospitals will spend more resources on improving the patient’s experience and understanding the patient’s perception. Expansion of the CAHPS Program to other services.

17. Questions?

18. Thank you!