Editors note: CMS mandates that acute care hospitals must participate in the HCAHPS survey. This survey, which is conducted by CMS-approved vendors, is composed of 32 questions for patients to answer concerning the quality of care they experienced in the hospital. As a component of the value based payment system, a hospital can gain or lose reimbursement dollars based on their performance in this survey.
In 2016 CMS will add a CAHPS survey tool (OAS) to hospital Outpatient Surgery as well as Outpatient Surgery Centers, and at some point, a similar survey will affect Emergency Departments as well as physicians.
J.L. Morgan & Associates has been conducting HCAHPS surveys for a number of years and several hospitals have asked Morgan how they can improve their survey scores.
To that end, J.L. Morgan & Associates undertook a study of over 50,000 surveys the group had done and has on file, looking for what survey components were most likely to correlate with a positive view of the hospital.
Most of the survey questions have four potential answers: never; sometimes; usually; always. CMS uses the top-box methodology where they only score the highest response, such as “always.” J. L. Morgan used the Patient-level Pearson correlations from CMS to evaluate top-box relationships. For example, “Communication about Medications” had a 0.42 Pearson score related to “would recommend the hospital to friends and family” which means that of all the patients who answered “always,” 42 percent would recommend the hospital.
Using these correlations, J.L. Morgan & Associates was able to find the components of the survey that would have the greatest effect on a positive score for the hospital.
The importance of patient satisfaction escalates each year. Not only does the hospital have a clinical obligation to improve their results, but a financial one as well. With over 30 individual measures to address as part of the HCAHPS survey, where should hospitals concentrate their efforts?
From the time period of July 2014 to June 2015, over 50,000 patient surveys were evaluated to identify trends within the individual HCAHP measures for each of the eleven composites. Using a confidence level of (95 percent) and confidence interval of (< +/- .5 percent), these results were then compared with the public data from CMS HCAHPS Patient-Level Correlations Report. The following recommendations are based on our results from the study. Focusing on these individual measures proved to have the greatest impact within each composite group. These include:
Pain Management - Correlation Score (0.48)
While the majority of hospitals seem to score well regarding “help with pain,” the major drop-off comes in the second measure for “pain well controlled.” This measure typically scored 8 to 11 percent lower than the other pain management measures.
Patients reported that, while hospitals are aware of their pain concerns, they are not meeting their expectations in controlling their level of pain. A number of hospitals use the “0 to 10” pain scale to help manage pain. Hospitals must determine whether this is a practice they utilize each time they check in on the patient, or is it hit-and-miss for capturing this information.
Care Transition - Correlation Score (0.45)
This composite which focuses on the transition from hospital to the patient’s home, is also the area with the greatest opportunities for improvement. Currently, the national average is at (52) and has shown very little movement over the last three quarters. While all areas could be addressed, the main measure which affects the overall composite score is “staff took my preferences into account.” This measure scored between 11 to 13 percent lower than the other care transition measures. This displays that patients do not feel their family members are being engaged in their care. Impress upon your staff that whenever possible, any interaction involving the patient’s care should include their family or caregiver.
Communication about Medications - Correlation Score (0.42)
This is one area where the data and results clearly showed a 19 to 21 percent discrepancy from one measure compared to another as part of the composite score. While patients agree they are being informed on “what the medication was for,” the results are not the same for “describe possible side effects.” The reason for such a disparity seems to focus more on a lack of patient education, rather than a hospital’s non-compliance.
Put simply, a hospital stating “you may become dehydrated while taking this medication,” is not the same as “here are the possible side effects you may experience while taking this medication.” While this may seem arbitrary to providers, actually saying the words “side effects” helps the patient lock-in on what they need to look for while taking their medication.
Responsiveness - Correlation Score (0.44)
While patients feel they are getting help to the bathroom as soon as they wanted it, the results fall for the next measure of “pressed the call button.” This measure scored 5 to 7 percent lower than the others in the group. This result should not come as a shock to anyone, but the problem remains that the perception is nursing staff is not meeting the patient’s expectations when the call button is pressed.
To help manage these expectations, consider scripting actual times such as “we will respond within 3 to 5 minutes”, instead of “just a few minutes.” This will set a range of expectations.
Summary
Improving HCAHPS results can be a daunting task if you try to affect 32 issues at once. Utilizing your HCAHPS’s vendor’s reporting tools can help identify the key areas you should focus on. Concentrating on just four or five areas at a time will improve your staff’s understanding on what they need to focus on to improve patient satisfaction results.