Emerging Challenges in Primary Care TARGETING THE PATIENT EXPERIENCE

Transcription

1 Emerging Challenges in Primary Care TARGETING THE PATIENT EXPERIENCE

2 Marlene R. Wolf, MD, FAAFP Family Practice Lifetime Medical Consulting, LLC Coral Springs, FL Clinical Assistant Professor of Family Medicine Nova Southeastern University s College of Allopathic Medicine, Fort Lauderdale, Florida Faculty 2

3 Disclosures Marlene R. Wolf, MD, FAAFP serves as the owner/consultant for Lifetime Medical Consulting, LLC. 3

4 4

5 Learning Objectives 1. Define Patient Experience & How it s Measured 2. Describe today s Healthcare World. 3. Outline the importance of the Patient Experience. 4. Understand and apply the H.E.L.P. communication method. H = Hello E = Empathy L = Language P = Patient & Plan 5

6 PRE-TEST QUESTIONS 6

7 Pre-test ARS Question 1 Better patient experience derives from the clinician s (Physician, PA, NP) amount of time with the patient not quality of time. 1. True 2. False 7

8 Pre-test ARS Question 2 Excellent patient experience and more effective communication does not improve clinical outcomes. 1. True 2. False 8

9 Pre-test ARS Question 3 The clinician s (Physician, PA, NP) care influences only 3 out of a total of 25 questions in the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey! 1. True 2. False 9

10 Pre-test ARS Question 4 Patient experience CAHPS ratings are primarily influenced by factors outside the clinician s (Physician, PA, NP) control such as nursing and environment. 1. True 2. False 10

11 Pre-test ARS Question 5 The patient experience and subsequent CAHPS ratings do not directly affect payment to the clinician (Physician, PA, NP) and hospital. 1. True 2. False 11

12 ON TARGET DEFINE & MEASURE PATIENT EXPERIENCE 12

13 (Institute for Healthcare Improvement, 2017) 13

14 (Wild, 2012, slide 5) 14

15 DEFINING PATIENT EXPERIENCE Patient experience interactions with the health care system, from health plans, doctors, nurses, and staff in hospitals, physician practices, and other health care facilities. (Agency for Healthcare Research and Quality, October 2016) 15

16 ON TARGET MEASURING PATIENT EXPERIENCE by CAHPS The CAHPS program is funded and overseen by AHRQ CAHPS. "Consumer Assessment of Healthcare Providers and Systems".represents a standardized approach to gathering, analyzing, and reporting information on consumers' and patients' experiences with health care services. (AHRQ, October 2016) 16

17 ON TARGET CAHPS SURVEY TYPES over 17 Surveys Administered by CMS (Centers for Medicare & Medicaid Services) Accountable Care Organizations (ACO) participating in Medicare initiatives Adult Hospital (HCAHPS) Group practices participating in the Physician Quality Reporting System (PQRS) Home and Community-Based Services Home Health Care Hospice In-Center Hemodialysis Outpatient and Ambulatory Surgery Surveys Available From AHRQ Health Plan Clinician & Group (CG-CAHPS) Surgical Care Child Hospital Dental Plan Experience of Care and Health Outcomes (ECHO) American Indian Nursing Home (AHRQ, October 2016) 17

18 HCAHPS SURVEY (H=Hospital) Questions from HCAHPS March of 25 Questions related to Clinician YOUR CARE FROM DOCTORS 5. During this hospital stay, how often did doctors treat you with courtesy and respect? ο Never ο Sometimes ο Usually ο Always 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? (HCAHPS Survey, March 2017) 18

19 CMS USE OF CAHPS Hospital Value-Based Purchasing Program CMS is adjusting a portion of payments to hospitals based on their performance on the survey and the quality of their clinical care. (Agency for Healthcare Research and Quality, CAHPS, March 2016) CMS Innovation Ctr - Pay for Performance models Reported publicly:

20 ON TARGET TRANSPARENCY OF CAHPS CAHPS survey. is available for any organization to use for its own purposes. (AHRQ,CAHPS, March 2016) 20

21 ON TARGET COMPENSATION & ACCOUNTABILITY Some organizations incorporate the survey results into programs that reward.providers for providing highquality care (AHRQ, CAHPS, March 2016) 21

22 CMS INNOVATION CENTER The Innovation Center.test models that improve care, lower costs, and better align payment systems to support patient-centered practices VALUE-BASED HEALTHCARE PROGRAMS (short list) Hospital Value Based-Purchasing (VBP) MACRA - Merit-Based Incentive Payment Program (MIPS) & Alternative Payment Models (APM) Bundled Payment Care Initiative (BPCI) Accountable Care Organizations (ACO) - Advanced Payment Medicare Shared Savings Programs (MSSP) & ERSD Initiative Comprehensive Care for Joint Replacement Model (CJR) Hospital Readmission Reduction Program Primary Care Transformation -Comprehensive Primary Care Initiative (CPC) Hospital-Acquired Condition Reduction Program (HAC) Oncology Care Model (CMS, n.d.,a) 22

23 Value-based Healthcare What matters to the patient! Value = quality & service / cost 23 ( Health Catalyst, 2016)

24 Alternative Payment Model Comprehensive Primary Care Plus (CPC+) - January 2017 Performance-Based Incentive Payment. CPC+ will reward practices based on their performance on patient experience. (CMS, n.d.,b) 24

25 ON TARGET IMPORTANCE OF PATIENT EXPERIENCE 25

26 (as cited in Saama,2015, slide 7) 26

27 For Clinicians Better Patient Experience Is Good Medicine Ø Greater Clinician Satisfaction Ø Lowers Medical Litigation Ø Lowers Clinician Frustration Ø Lowers Burn-out 27 (Berra, 2015)

28 Patient Experience Component of Certification & Compensation Ø Certification: American Board of Medical Specialties MOC exams include core CG-CAHPS (Clinical & Group) items Ø Private & public payers use CG-CAHPS in their compensation structures (Miller, 2013) 28

29 For Patients Better Patient Experience Improves Clinical Outcomes Ø Increases Patient Adherence Ø Lower 30-day Readmission Rate Ø Lower Inpatient Mortality Rate Ø Decrease Utilization of Care Services Ø Lower Total Annual Charges 29 (Berra, 2015)

30 Wall Street Journal ( as cited in Miller, 2013) 30

31 Pre-appointment Social Media Use On-line Reputation Reputation-management Firm 31 (as cited in Mahoney, August 3, 2016)

32 (as cited in Meyer, June 14,2014) 32 SHARED ON SOCIAL MEDIA DIGITAL FOOTPRINT Blogs; Surveys; Website reviews Posting images & videos, Real-time:

33 33 (HIPPA Cartoons, 2016)

34 ON TARGET H.E.L.P. WITH PATIENT EXPERIENCE 34

35 Song: HELP! By The Beatles Help, I need somebody Help, not just anybody Help, you know I need someone, help. Help me if you can, I'm feeling down And I do appreciate you being round Help me, get my feet back on the ground Won't you please, please help me, help me, help me, oh Songwriters LENNON, JOHN / MCCARTNEY, PAUL Published by Lyrics Sony/ATV Music Publishing LLC (Metrolyrics 2017) 35

36 THE CLINICIAN (Physician, PA, NP) is the CHIEF PATIENT EXPERIENCE OFFICER PaEent Experience EffecEve CommunicaEon Bedside Manner ReputaEon 36

37 Communication is the most common medical procedure Over 200,000 times in an average practice lifetime Minimal physician education in communication skills Communication skills decline throughout residency (Miller, 2013, slide 35) 37

38 38

39 COMMUNICATION STATISTICS MESSAGES RECEIVED First Impression: 7 seconds 7 % Verbal Words 38 % Voice Tone 55% Non-verbal Body Language (Silverman, 2014 p.18) 39

40 H.E.L.P. for Clinicians H = Hello E = Empathy L = Language P = Patient & Plan 40

41 H = Hello Ø Hello introduction Ø Greeting, Please, Thank you! Ø Non-verbal body language Ø Mindfulness Ø Bedside manner reputation 41

42 OUR BODY LANGUAGE Ø Gestures handshake, touch on shoulder Ø Body angle sitting Ø Facial expressions Voice Direct eye contact (Silverman, 2014) 42

43 Non-Verbal Communication Our Body Language Whether someone can see you or not, your body language and facial expressions control your feelings which control how you communicate with others (Silverman, 2014 p.20) 43

44 E = Empathy Ø Elicit - chief concern & agenda Ø Engage patient to tell you their story Ø Empathy seen, heard, accepted Ø Communicate with open-ended questions (Cray, 2013) 44

45 Recognizing & Responding to Fears of the Clinician Patients have too many presenting concerns per visit. The average outpatient has 1.7 concerns. Eliciting a list takes ~ 32 seconds & significantly reduces frequency of doorknob questions. It takes away from vital time for assessing & treating the chief complaint. The first concern usually not main concern. The door knob questions are more common when an exhaustive list is not elicited early on. (Miller, 2013, slide 42) 45

46 L = Language Ø Look and non-verbal Language Ø Active listening Ø Open-ended questions - Tell me more Ø Language and health literacy Ø Check your self-disclosure! (Cray, 2013) 46

47 LOOK AT THE ROOM DYNAMICS (HIPPA Cartoons, 2016) 47

48 ACTIVE LISTENING (QuoteAddicts, n.d.) 48

49 P = Patient & Plan Ø Plan with patient -Shared decision making Ø Health literacy Ø Explain the Mysteries of the Medical World Ø Plan closure to disengage 49

50 SHARED DECISION MAKING HEALTH LITERACY (as cited in AssureHomeHealth, 2013) 50

51 Explain Mysteries of the Medical World Ø Who is the Clinician & Care Team? Ø What is happening? Ø What are you doing to me? Ø When will I know about tests results? Ø Where will it hurt me? Ø Why are you doing this rather than that? Ø How will this affect my life? (Cray, 2013) 51

52 P = PLAN CLOSURE Ø Summarize visit Ø Share plan Ø Review next steps Rx, visits, testing Ø Disengage with empathy, hope & support (Cray, 2013) 52

53 H.E.L.P. for Chief Patient Experience Officer EFFECTIVE COMMUNICATION H = Hello E= Empathy L= Language P= Patient & Plan 53

54 POST-TEST QUESTIONS 54

55 Post-test ARS Question 1 Better patient experience derives from the clinician s (Physician, PA, NP) amount of time with the patient not quality of time 1. True 2. False 55

56 Post-test ARS Question 2 Excellent patient experience and more effective communication does not improve clinical outcomes. 1. True 2. False 56

57 Post-test ARS Question 3 The clinician s (Physician, PA, NP) care influences only 3 out of a total of 25 questions in the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey! 1. True 2. False 57

58 Post-test ARS Question 4 Patient experience CAHPS ratings are primarily influenced by factors outside the clinician s (Physician, PA, NP) control such as nursing and environment. 1. True 2. False 58

59 Post-test ARS Question 5 The patient experience and subsequent CAHPS ratings do not directly affect payment to the clinician (Physician, PA, NP) and hospital. 1. True 2. False 59

60 Questions? Comments! TARGETING THE PATIENT EXPERIENCE H = Hello E= Empathy L= Language P= Patient & Plan Marlene R Wolf, MD, FAAFP Lifetime Medical Consulting, LLC 2017

61 REFERENCES Agency for Healthcare Research and Quality, (October 2016), About CAHPS, Retrieved from Agency for Healthcare Research and Quality, CAHPS, (March 2016) CAHPS : Assessing Health Care Quality From the Patient's Perspective" Retrieved from AssureHomeHealth, (2013) Medication management, Retrieved from management/ Berra, A, (2015) 5 Myths That Physicians Believe About Patient Experience Advisory Board CMS, (n.d.,a), Center for Medicare and Medicaid Innovation, Retrieved from CMS, (n.d.,b) Comprehensive Primary Care, Retrieved from Cray, M.I.,MD., (2013), Introduction to Physician Communication Skills in Clinical Medicine, [PowerPoint], Retrieved from utm_source=slideshow02&utm_medium=ss &utm_campaign=share _slideshow 61

62 REFERENCES Health Catalyst, (2016) Retrieved from Accountable Care Organization (ACO) Solutions, HCAHPS Survey March 2017 Retrieved from HIPPA Cartoons (2016), Private Cartoons, R.J.Romero, Retrieved from Institute for Healthcare Improvement (IHI), (2017) The IHI Triple Aim, Retrieved from Mahoney, (August 3,2016), The Three Healthcare Revolutions [Powerpoint] Retrieved from sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahukewi5 p-c_1- fsahvcoyykhu16c68qjrwibw&url=http%3a%2f%2fwww.slideshare.net%2f kmahoneyutah%2funiversity-ofutahhealthcare3revolutionsslides&bvm=bv ,d.eWE&psig=AFQjCNHe231S_anAB0pAbUSXKBHOFASD- A&ust= Metrolyrics, (2017) Help! Beatles lyrics, Retrieved from Meyer, R (June 17,2014) What is the role of Social Media in Healthcare? From Focus on Patients 62

63 REFERENCES Miller, J., (2013). Patient Experience and Relationship Centered Communication, [PowerPoint], Retrieved from: sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&sqi=2&ved=0ahuke wjdqdog9cnsahxctcykhx6xbxmqfgg9mau&url=https%3a%2f%2fosteopathic.or g%2finside-aoa%2fevents%2fomed%2fomedpresentations%2fdocuments%2f2013%2520omed%2520presentations%2fclevelan d-clinic- miller.ppt&usg=afqjcnhfuqznlnogcqmkrdatwftbdpzmvg&sig2=facbxhlwc2- Hk2z7y6pJew&bvm=bv ,d.eWE Nguyen, K (May 24, 2016) Interoperability with 3 Promising Innovations in Healthcare QuoteAddicts, (n.d.) Jerome Groopman Quote, Retrieved from Saama, (October 8,2015) Improving Patient Sentiment & Experience [Powerpoint] Retrieved from sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahukewirubbyvu fsahub6yykhdhydm4qjrwibw&url=https%3a%2f%2fwww.slideshare.net%2fsaamabiz %2Fimproving-patient-sentiment-and-experience&bvm=bv ,d.eWE&psig=AFQjCNGBP07- whmexnimkucttv4cjdjsqw&ust= Silverman, D. & Carr, T, (2014) It s Just a Conversation What To Say And How To Say It in Business, Retrieved from Wild, R, (2012) CMS Vision of Meaningful Use of HIT [Powerpoint] Retrieved from sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahukewi9koi3ufsahwepcykhtxucemqjrwibw&url=https%3a%2f%2fwww.slideshare.net%2fgatelehe alth%2fdr-richardwild-31612&psig=afqjcneumpp_btpahe2e9bu8l8ftduiziq&ust=