Presentation on theme: "(CAHPS) Experience of Care Surveys From Design to Implementation"— Presentation transcript:
1 (CAHPS) Experience of Care Surveys From Design to Implementation Liz Goldstein, Ph.D.AHRQ Annual ConferenceSeptember 9, 2012
2 The Triple AimBetter careHealthier people & communitiesLower cost
3 Patient Experience Surveys Patient Experience Surveys Support the Triple Aim Through Public Reporting, Pay for Performance, and Quality ImprovementTriple AimPublic ReportingPay for PerformanceQuality ImprovementPatient Experience Surveys
4 CAHPS Surveys Measure Patient Experience, Not Patient Satisfaction CAHPS asks patients whether key things happened in their health care.Provides actionable information to improve the quality of care.Focus is on important aspects of care such as communication, access, coordination of care, and patient involvement.Less subjective than asking about satisfaction.
5 CAHPS Surveys Currently Implemented by CMS Hospital (HCAHPS)Home Health Care (HHCAHPS)Health PlanPrescription Drug PlanFee-for-Service
7 Public Reporting on www.medicare.gov “Compare” web sites help users gain information and make decisionsLinks to “Compare” web sites
8 Home Health Compare Provides Information About Home Health Agencies
9 Compare up to 3 Agencies Simultaneously Criteria IncludeServices ProvidedNursing CarePhysical TherapyOccupational TherapySpeech TherapyMedical Social ServicesHome Health AideQuality of Patient CareManaging Daily ActivitiesManaging Pain and Treating SymptomsTreating Wounds and Preventing Pressure SoresPreventing HarmPreventing Unplanned Hospital CareAnd Patient Experience Survey Results…
10 Patient Experience Survey Results Home Health CAHPS (HHCAHPS) Percent of patients who…Reported that their home health team gave care in a professional way.Reported that their home health team communicated well with them.Reported that their home health team discussed medicines, pain, and home safety with them.Gave their home health agency a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).Reported YES, they would definitely recommend the home health agency to friends and family.Composite MeasuresGlobal Scores
11 Incentive for Home Health Agencies to Participate and Report the Data Reporting HHCAHPS ResultsHome Health Annual Payment updateNo Report = Less Money
13 Data Available on Hospital Compare General Information about HospitalsPatient Experience DataClinical DataAdministrative Data
14 Example of Patient Experience Data Presented on Hospital Compare CAHPS MeasuresHospital 1Hospital 2Hospital 3Patients who reported that their nurses “Always” communicated well.66%73%68%Patients who reported that their doctors “Always” communicated well.75%80%72%Dimensions based on patient responses to HCAHPS Surveys.Data used in Hospital Value Based Purchasing.Allows the public to see specific, detailed comparisons among providers.
18 CMS Plan Ratings System CMS created the Five-Star Plan Rating System to help consumers, their families, and caregivers compare health plans. And in the case of Medicate Advantage plans to reward high-performing plans with bonuses.ExcellentAbove averageAverageBelow averagePoorPlan Ratings
19 Adjustments to Patient Experience Data to Ensure Comparable Information Mix of patients.Mode of survey administration (if applicable).
21 Hospital Value Based Purchasing Hospital Value Based Purchasing links a portion of CMS payment to providers based on performance on a set of quality measuresHospital Value Based Purchasing established by the Patient Protection and Affordable Care Act of 2010 (Public Law )Affects payment for patients discharged October 1, 2012 (FY 2013) and forward
22 Here is How it Works:Hospital VBP Incorporates Patient Experiences into Providers’ Total Performance ScoreClinical Process Domain ScorePatient Experience Domain ScoreTotal Performance Score+=Patient Experience Surveys (CAHPS)70%30%Payment
23 HCAHPS and Hospital VBP Scoring Eight HCAHPS Dimensions in Hospital VBPCommunication with NursesCommunication with DoctorsStaff ResponsivenessPain ManagementCommunication about MedicinesDischarge InformationCleanliness & Quietness of Hospital Environment (combined)Overall Rating of HospitalPercent of patients who chose “Top-box” response
24 Most Dimensions Are Composed of Individual Survey Items Communications With Nurses(Items 1, 2, 3 )1. During this hospital stay, how often did nurses treat you with courtesy and respect?2. During this hospital stay, how often did nurses listen carefully to you?3. During this hospital stay, how often did nurses explain things in a way you could understand?Dimension:Communications with Doctors(Items 5, 6, 7)5. During this hospital stay, how often did doctors treat you with courtesy and respect?6. During this hospital stay, how often did doctors listen carefully to you?7. During this hospital stay, how often did doctors explain things in a way you could understand?
25 Patient Experience Domain Score Calculation HCAHPS Base ScoreFor each of the Eight HCAHPS Dimensions:Achievement Points (0-10) and Improvement Points (0-9) are calculatedThe larger of the Improvement Points or Achievement Points for each Dimension is usedDimension scores are summed to create the HCAHPS Base Score : 0 to 80 pointsConsistency Points0 to 20 pointsTarget hospital’s lowest performing HCAHPS Dimension during the Performance PeriodIf the lowest scoring Dimension is below the national median,then the hospital earns between 0 and 19 Consistency PointsMax Patient Experience Domain Total Score = 100 points
26 Patient Responses to Survey Items Patient Experience Domain Score Patient Experience Central Role in Hospital VBPPatient Responses to Survey Items8 DimensionsPatient Experience Domain Score30 % of Total ScorePayment
27 Medicare Advantage Quality Ratings Quality bonuses are required as part of the Affordable Care Act for MA contractsCMS is conducting a demonstration to determine whether additional quality-based payments lead to more rapid and larger year-to-year quality improvementsQuality bonuses are based on the MA Plan Ratings.
28 Plan Ratings – Multiple Levels Example MeasuresExample DomainsOverall and Summary Rating (1/2 stars)Overall (MA-PD) orSummary (Part C and Part D)Staying HealthyBreast Cancer ScreeningAnnual Flu VaccinePatient SafetyHigh Risk Med Use75% screened75% vaccinated10% members receive HRM
29 9 Domains of Plan Ratings Ratings of Health Plans (Part C)Staying healthy: screenings, tests, vaccinesManaging chronic (long-term) conditionsMember experiences with their health planMember complaints, problems getting services, and choosing to leave the planHealth plan customer serviceRatings of Drug Plans (Part D)Drug plan customer serviceMember complaints, problems getting services, and choosing to leave the planMember experience with plan’s drug servicesDrug pricing and patient safety
30 Sources of Data for Plan Ratings Surveys (CAHPS Surveys and Health Outcomes Survey)Clinical Data (Healthcare Effectiveness Data and Information Set, HEDIS)CMS administrative dataData collected by CMS contractors
31 Quality Bonus Payments Under Current Law and CMS Demonstration
33 Quality ImprovementPlan/provider quality improvement (QI) strategies should focus on improving overall care that enrollees/patients are receiving across the full spectrum of services.QI strategies should not be limited to only the measures included in the public reporting and VBP initiatives.
34 Incentives for Quality Improvement Public ReportingValue-based Purchasing
35 High Performer Icon for Plans CMS highlights contracts receiving a rating of 5 stars with this icon:Information on Medicare.gov notes that beneficiaries can enroll in 5-star contracts at any time during the year.This plan gotMedicare’s highestrating (5 stars)5
36 Low Performer Icon for Plans Since 2011, CMS has marked contracts rated less than 3 stars with a low performer icon:Beginning this fall, beneficiaries will be unable to use MPF to enroll in these contracts.MPF messaging and Medicare representatives will also discourage enrollment into these contracts.
37 Examples of Tools for Quality Improvement Medicare Plan ReportsCAHPS Quality Improvement Guide
38 Excerpt from Health Plan Report to use for Quality Improvement
39 Plan Report Points out Strengths and Opportunities for Improvement
41 Recent Enhancements to CMS Patient Experience Surveys Care Transitions measures added to Hospital CAHPS starting July 2012 on a voluntary basis and January 2013 nationally.Care Coordination items added to Medicare health plan survey in early 2012.
42 Future Directions In-Center Hemodialysis CAHPS Accountable Care OrganizationsHealth Insurance ExchangesMedicaid Home and Community-Based ServicesHospiceEmergency RoomOutpatient Surgical