1. APRIL 21 2015 HCAHPS Patient Experience Surveys: Current and Future Requirements

2. Agenda HCAHPS Overview Survey updates Communicating with patients about the HCAHPS Survey New STAR rating program

3. Consumer Assessment of Healthcare Providers and Systems  Produce comparable data for public reporting  Create incentives to improve  Enhance public accountability and transparency

4. HCAHPS Overview

5. HCAHPS Survey Revision Mail survey currently available in English, Spanish, Chinese, Russian, Vietnamese, and Portuguese Telephone survey currently available in English and Spanish New: Response option for “Portuguese” is being added to question 32

6. Hospital VBP Time Periods: Performance Period FY 2016:  January 2014 – December 2014  Must have 100+ completed HCAHPS Surveys in Performance Period to be included in Hospital VBP  Four Hospital VBP Domains for FY 2016:  Clinical Process of Care (8 measures)  Patient Experience of Care (HCAHPS; 8 measures)  Outcomes (Mortality, safety, HAI; 7 measures)  Efficiency (Medicare spending per beneficiary; 1 measure)  Patient Experience Domain comprises 25% of Hospital VBP TPS in FY 2016  Clinical Process: 10%; Outcomes: 40%; Efficiency: 25%

7. Hospital VBP Time Periods: Calendar Year 2015 will be the Performance Period for the FY 2017 Hospital VBP program –Coupled with the Baseline Period of CY 2013 Baseline Period for the FY 2019 program –Coupled with the Performance Period of CY 2017 Information on calculating HCAHPS Hospital VBP Domain Score http://www.hcahpsonline.org/Files/Hospital%20VBP%20Domain%20Score% 20Calculation%20Step-by-Step%20Guide_V2.pdf

8. MBQIP 2015-2016 HCAHPS reporting requirement for MBQIP will be attached to FLEX and SHIP funding. Beginning in September 2015

9. Data Submission Deadlines

10. Updates to HCAHPS Quality Assurance Guidelines (QAG) V10.0

11. HCAHPS Communication Guidelines Hospitals SHOULD NOT Ask patients for a certain score Indicate that their goal is to receive a certain score Show the HCAHPS survey or cover letter to the patient prior to survey administration Wear a button which says “10” or “Always” Hospitals SHOULD Encourage response to the survey “It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge.” Improve the patient experience Distribute the communication guidelines

12. HCAHPS Communication Guidelines New : Hospitals/Survey vendors or their agents are not allowed to display signage denoting “Always” or “10” New: Hospitals are not allowed to emphasize the HCAHPS questions or response options in posters, white boards, rounding questions, in room television, or other media accessible to patients:

13. Examples of inappropriate messages include - “We expect to be the best hospital possible.” “Our goal is to always address your needs.” “Let us know if we are not listening carefully to you.” “We treat our patients with courtesy and respect.” “In order to provide the best possible care, please tell us how we can always…” “Our doctors and nurses always listen carefully to you.” “We want to always explain things to you in a way you can understand.” “We want you to recommend us to family and friends.”

14. Examples of statements that comply with HCAHPS protocols include - “ We are looking for ways to improve your stay. Please share your comments with us.” “What can we do to improve your care?” “We want to hear from you, please share your experience with us.” “Please let us know if you have any questions about your treatment plan.” “Let us know if your room is not comfortable.”

15. New for HCAHPS – STAR ratings As part of a new initiative to add five-star quality ratings to its Compare Web sites, the Centers for Medicare & Medicaid Services (CMS) will add HCAHPS Star Ratings to the Hospital Compare Web site Star Ratings page on the HCAHPS Web site at http://www.hcahpsonline.org.

16. Why Star Ratings for Hospital Compare? Consumers are the primary audience for Hospital Compare, along with other important stakeholders The National Quality Strategy envisions effective public reporting as a key driver for improving the health care system as a whole:  Consumers consult ratings  Consumers choose the care that is best for them and their families  Providers are incentivized to improve quality to retain existing patients and to attract new ones

17. Principles for Star Ratings Report what is most important to patients in a way they can understand Leverage knowledge and lessons learned from existing sites Not all measures are appropriate for Star Ratings Transparency of methodology and display with stakeholders Supplement information already on Hospital Compare Coordinate across all Compare Web site

18. Overview of HCAHPS Star Ratings CMS added Star Ratings for HCAHPS measures beginning with the April 2015 public reporting on Hospital Compare (Posted April 16 2015) Patients discharged from July 2013 to June 2014 No previous HCAHPS information was removed from Hospital Compare when HCAHPS Star Ratings are added to the Web site

19. New for HCAHPS – STAR ratings HCAHPS Composite Measures 1. Communication with Nurses (Q1, Q2, Q3) 2. Communication with Doctors (Q5, Q6, Q7) 3. Responsiveness of Hospital Staff (Q4, Q11) 4. Pain Management (Q13, Q14) 5. Communication about Medicines (Q16, Q17) 6. Discharge Information (Q19, Q20) 7. Care Transition (Q23, Q24, Q25) HCAHPS Individual Items 8. Cleanliness of Hospital Environment (Q8) 9. Quietness of Hospital Environment (Q9) HCAHPS Global Items 10. Overall Hospital Rating (Q21) 11. Recommend the Hospital (Q22

20. New for HCAHPS – STAR ratings 100 Completed Survey Minimum for HCAHPS Star Ratings In order to receive HCAHPS Star Ratings, hospitals must have at least 100 completed HCAHPS Surveys over a given four-quarter period. In addition, hospitals must be eligible for public reporting of HCAHPS measures. Hospitals with fewer than 100 completed HCAHPS Surveys will not receive Star Ratings; however, their HCAHPS measure scores will be publicly reported on Hospital Compare.

21. Process of Creating HCAHPS Star Ratings Step 1 Construction and Adjustment of HCAHPS Linear Mean Scores  All survey responses are used in the construction of HCAHPS Star Ratings  Survey responses are converted into linear mean scores  The linear mean score for an HCAHPS measure summarizes all the responses to the survey items included in that measure

22. HCAHPS Star Ratings Linear Mean Scores HCAHPS Survey responses are converted to a 0-100 score as follows:  Never 0; Sometimes 33 1/3; Usually 66 2/3; Always 100  Strongly disagree 0; Disagree 33 1/3; Agree 66 2/3; Strongly agree 100  No 0; Yes 100  Rating 0 = 0; Rating 1 = 10; … Rating 10 = 100  Definitely no 0; Probably no 33 1/3; Probably yes 66 2/3; Definitely yes 100 HCAHPS scores are averaged to obtain linear means for each measure

23. Process of Creating HCAHPS Star Ratings Step 2 Conversion of Linear Mean Scores to HCAHPS Star Ratings A statistical clustering technique is applied to HCAHPS linear mean scores  Clustering identifies star groups that maximize differences between groups and minimize differences within groups  There are no pre-determined quotas for the star categories  Same method is used for many CMS Part C and Part D Star Ratings

24. Converting Linear Mean Scores to HCAHPS Star Ratings 1, 2, 3, 4 or 5 whole stars are assigned to each HCAHPS measure –No half-stars are assigned

25. Process of Creating HCAHPS Star Ratings Step 3 Calculation of the HCAHPS Summary Star Rating

26. HCAHPS Summary Star Rating The HCAHPS Summary Star Rating combines the Star Ratings of all the HCAHPS measures The HCAHPS Summary Star Rating is the average of 9 elements:–  7 Star Ratings from the HCAHPS composite measures  Average of Cleanliness and Quietness stars  Average of Overall Rating and Recommend stars Normal rounding rules are applied to the HCAHPS Summary Star Rating average to assign 1, 2, 3, 4 or 5 whole stars –No half-stars are assigned

27. Example for Calculation of Summary Star Rating

28. HCAHPS Star Rating Cut Points for Patients Discharged Between July 1, 2013 to June 30, 2014

29. National Distribution of Star Ratings

31. Georgia’s Distribution of Star Ratings Total # of Georgia hospitals rated: 100 Average Star rating:3.2 % hospitals With 5 Stars: 4% % hospitals With 4 Stars: 30% % hospitals With 3 Stars: 46% % hospitals With 2 Stars: 18% % hospitals With 1 Star: 2%

32. Questions

33. GHA Contact Information KATHY MCGOWAN, VICE PRESIDENT OF QUALITY & SAFETY KMCGOWAN@GHA.ORGKMCGOWAN@GHA.ORG 770-249-4519 JOYCE REID, VICE PRESIDENT OF COMMUNITY HEALTH CONNECTIONS JREID@GHA.ORGJREID@GHA.ORG 770-249-4545 LISA CARHUFF, QUALITY IMPROVEMENT/PATIENT SAFETY SPECIALIST LCARHUFF@GHA.ORGLCARHUFF@GHA.ORG 770-249-4553