THE SURVEY SAYS A SNAPSHOT OF. HealthStream s Pilot of the NEW EMERGENCY ROOM PATIENT EXPERIENCES. with Care Survey (ED-CAHPS)

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1 THE SURVEY SAYS A SNAPSHOT OF HealthStream s Pilot of the NEW EMERGENCY ROOM PATIENT EXPERIENCES with Care Survey (ED-CAHPS) WHITE PAPER Berke Bilbay, Associate Vice President, Research Reporting & Platforms Amanda Holland, Product Director, Patient Insights Healthcare s Leader in Workforce Development

2 In early 2014, CMS concluded its field test of a new CAHPS survey Emergency Room Patient Experiences with Care, commonly referred to as ED-CAHPS. This survey will eventually become another required CAHPS survey. CMS tested the survey among patients discharged from the emergency room and patients admitted to the hospital from the emergency room. While CMS has indicated that it plans to release the final surveys this summer, they have not indicated when they will release their plans for national implementation. However, based on the timelines for other CAHPS programs, HealthStream anticipates that this survey could become mandatory as early as 2015 or To ensure our clients are at the forefront of the new ED-CAHPS survey, HealthStream conducted its own pilot this winter among 22 emergency departments across the country. The goal of conducting a pilot survey parallel to the CMS field test was to help prepare hospitals that want to adopt this survey before it becomes required. The results of the pilot have enabled HealthStream to provide benchmarks and begin developing best practices that support this new CAHPS survey. HEALTHSTREAM S CAHPS- ALIGNED SURVEY APPROACH HealthStream has been using CAHPS-style questions, rating scales, and protocols since the inception of HCAHPS. This CAHPS-aligned approach provides continuity across the entire patient experience of care and ensures an easier transition to new CAHPS surveys as initiatives expand to cover other aspects of the patient experience beyond the inpatient setting. As a result, there is much commonality between the new CMS survey and the HealthStream Emergency Department survey. New Required ED-CAHPS Survey CMS tested its new CAHPS survey among patients discharged from the emergency room and those admitted to the hospital from the emergency room. Whether patients admitted will receive a separate survey in addition to their HCAHPS survey, or if supplemental questions will be added to the HCAHPS survey, is yet to be seen. CAHPS Initiative Participation Requirements CAHPS Sponsor Key Program Requirements Recent Developments Emergency Room Patient Experiences with Care (ED- CAHPS) Expected to become required for hospital emergency departments CMS National Implementation anticipated to begin in 2015/2016. Pilot surveys available for review. Anticipated Requirements: Contract with a CMSapproved vendor to conduct the survey. CMS field test concluded in February CMS has not yet released the official participation requirements, final survey(s), or vendor certification requirements. Continuous interviewing. Pay-for-participation. 2 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

3 THE ED-CAHPS SURVEY Enitatate volum quat. Asimaximusa prerrum que natquia The survey that CMS tested includes over 60 questions. However, the final survey may be shorter. It will be required for hospital emergency departments with sufficient volumes, as well as for patients discharged and those admitted through the ED. Patient eligibility requirements will be similar to HCAHPS rules, making it likely patients 18 years of age and older will be those surveyed. Once mandated, results will be displayed on the Hospital Compare website. The topics on the ED-CAHPS Survey include the following*: Arrival and Urgency of Treatment Wait Times Family & Friends Medication & Pain Tests/Treatments Interpreter Services Nurses Doctors Discharge Overall Rating Likelihood to Recommend Demographics *CMS has not released how the composites and questions will be rolled up. Emergency Room versus Emergency Department You may be asking yourself what terminology CMS will use for the survey and whether it will reference the emergency room as currently used in the survey title and within the question set, or rather use the more accepted term of emergency department. The Emergency Nurses Association (ENA) and the American College of Emergency Physicians (ACEP) have long used the term emergency department, but to date CMS has not referred to the survey as ER-CAHPS or ED-CAHPS, rather it has used the full name in all communication. Time will tell what the official acronym will be and if emergency room will continue to be the terminology referenced by patients. the reason why you were there? Less than 5 minutes, 5 to 15 minutes, or More than 15 minutes. These specific timeframes will become new performance standards on which emergency departments will be rated and will need to achieve in order to be successful with ED-CAHPS. The ED-CAHPS question set is very specific in its success criteria. Rather than asking the patient if he or she was satisfied with wait times in general, questions reference very specific timeframes. For example, Did you get care within 30 minutes of getting to the emergency room? and How long was it before someone talked to you about HealthStream.com contact@healthstream.com 3

4 KEY FINDINGS OF HEALTHSTREAM S ED-CAHPS PILOT SURVEY RESULTS Results of the HealthStream pilot include interview responses from 2,116 emergency department patients discharged from 22 hospitals across the United States. Hospitals included in the pilot were a representative sample both geographically and by overall ranking within the current HealthStream ED database. The surveys were conducted using our telephone methodology in February and March 2014 and used patient records not sampled for pilot clients in ongoing emergency department projects. TOP BOX RESULTS The HealthStream pilot data reveals that the items with the highest top box percentages are related to family members or friends being allowed to stay with the patient, communication regarding medication, understanding health problems or symptoms, and the courtesy and respect of nurses and doctors. Questions With the Highest Top Box Scores 4 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

5 The lowest-rated item has to do with communication regarding wait times: During this emergency room visit, did someone let you know how long you would wait before you got care for the first time? Questions With the Lowest Top Box Scores TopBox Score Overall Rating of Emergency Department Patients indicating Yes, definitely that they were informed about how long it would be before they received care gave overall rating scores 30% higher than those that indicated Yes, somewhat and 44% higher than those that said No. These results affirm the impact communication and keeping the patient informed have on the patient s overall experience. HealthStream.com contact@healthstream.com 5

6 Correlation Analysis Not surprisingly, the items most highly correlated with the overall rating question fell within the People Who Took Care Of You section of the survey and centered specifically around doctors and nurses attentiveness, such as spending enough time with the patient and treating him/her with courtesy and respect, as well as communication with the patient. The doctor items correlated slightly higher to overall ratings than the same questions regarding nurses. This held true for all three questions that were asked about nurses and doctors. Conversely, top box scores on items related to nurses scored just above those related to doctors around 1% for each of the three questions. This top box score trend is slightly different than HCAHPS where doctors score higher than nurses. The items that have the lowest correlations to the overall rating question are consistent with what we have seen in the HealthStream ED database. These items primarily center on medications, including During this emergency room visit, did you get medicine for pain? The item with the lowest correlation is During this emergency room visit, was your family member or friend allowed to stay with you when you wanted them with you? 6 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

7 Going to the Emergency Room When looking at items related to going to the emergency room, the reason for the visit does not seem to have an impact on scores. Thinking about this visit, what was the main reason why you went to the emergency room? Only 18% of respondents arrived at the emergency room in an ambulance. Top box percentages were slightly lower for those that arrived in an ambulance, which may be related to the seriousness of the issue. This result is similar to HCAHPS where people who rate their overall health low rate all questions slightly lower. HealthStream.com

8 THE IMPORTANCE OF COMMUNICATION In an urgent environment, communication and managing expectations are keys to improved patient ratings. Patients who said that someone let them know how long they would wait before they got care rated items much higher on the HealthStream pilot survey. An even more significant impact on scores can be seen in regards to the importance of being seen quickly. For patients with a great sense of urgency, 30 minutes can seem like an eternity. The data shows a large gap in ratings between those who received care within 30 minutes and those who waited longer. TopBox Score Overall Rating of Emergency Department Perhaps the most dramatic finding is that immediate communication with patients upon their arrival makes a profound difference in ratings. Patients who were addressed in under 5 minutes rated items significantly higher than those who were addressed in over 15 minutes. TopBox Score Overall Rating of Emergency Department 8 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

9 A DEEP DIVE INTO PAIN MANAGEMENT As noted earlier, the question on the survey related to getting pain medicine, During this emergency room visit, did you get medicine for pain?, had a much lower correlation (0.23) to the patient s overall rating than the question, During this emergency room visit, did the doctors and nurses do everything they could to help you with your pain (0.61). To further our understanding of the complicated nature of pain management in the emergency department, we took a deeper look into the data. First, patients are asked, During this emergency room visit, did you have any pain? Eighty eight percent of patients responded Yes. Of those patients, 62% received pain medication. Of the 38% of patients who had pain but did not receive pain medicine, nearly half of respondents still said Yes, definitely, the doctors and nurses did everything they could to help with the pain. An additional 20% said, Yes, somewhat. Yes, definitely Yes, somewhat No Q14. During this emergency room visit, did you get medicine for pain? 54% 8% 38% Q14. During this emergency room visit, did doctors and nurses do everything they could to help you with your pain? 44% 20% 34% Consequently, even in cases where patients did not receive pain medicine, they nonetheless rated the question more highly correlated to their overall rating of the care higher, indicating that contrary to what we typically believe, it seems there is not a direct link between administration of pain medicine and an increase in emergency department scores. It is yet to be seen if these two, very different questions, will each remain on the final survey. HealthStream.com contact@healthstream.com 9

10 THE BUSINESS CASE FOR STARTING ED-CAHPS EARLY Overall, emergency department ratings are the lowest among all patient experiences of care. Early adoption of the ED-CAHPS survey provides an opportunity to begin improvement efforts in advance of the mandate and affords organizations an understanding of the impact of potential new wait time standards. Staff members then will have more time to get on board with the survey, more fully understand what it measures, and have more insight into how to improve the patient experience before the survey becomes fully mandated and linked to pay-for-performance initiatives, such as Value- Based Purchasing. Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during this emergency room visit? 10 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

11 HEALTHSTREAM S SOLUTION FOR IMPROVING THE ED PATIENT EXPERIENCE AND ED-CAHPS RESULTS Approximately 28% of all acute care visits in the United States occur in the Emergency Department. With the final ED-CAHPS survey expected to become mandatory as early as 2015, now is the time to start assessing and improving patients experiences in your Emergency Department with a CAHPS-aligned survey approach. Hospitals that start early will get a jump-start on improvement efforts that will directly affecting ED- CAHPS measures, and eventually reimbursement. HealthStream partners with more than 600 Emergency Departments across the United States and offers the largest phone methodology database, and only ED- CAHPS database, in the industry. Our CAHPS-aligned process provides continuity across the entire patient experience and ensures a smooth transition to new CAHPS survey initiatives. Our BLG Consulting and Coaching Staff can help you on your improvement journey by developing leader competencies to achieve organizational goals, employing measurement tools to drive performance, and setting behavioral expectations to help define a culture of service excellence. To get started, complete our online diagnostic tool to see where to focus your efforts to start improving the patient experience in your Emergency Department. The Rapid ED Diagnostic is an online questionnaire that gathers insight into the strengths and opportunities of your Emergency Department specific to leadership, the patient experience, and patient flow of those admitted to the hospital. With the results of this 10-minute questionnaire, BLG Patient Experience Experts will make recommendations on where to focus and how to address the challenges you face. The ED Rapid Diagnostic may be accessed at HealthStream.com contact@healthstream.com 11

12 ABOUT THE AUTHORS Berke Bilbay, Associate Vice President, Research Reporting & Platforms, HealthStream, has more than ten years of experience with statistical analysis, advanced math, market research, survey design, research methodology, and the design and management of complex national databases. During thirteen years with HealthStream Research, his healthcare discovery papers have helped hospitals around the nation measure, improve, and thrive. Mr. Bilbay has been a successful conference presenter on HCAHPS and national databases and has taken part in nationally-broadcast healthcare webinars. He received his BA in Social Sciences and Math, and his MBA from Villanova University. Amanda Holland, Product Director, Patient Insights, HealthStream, oversees research, development, and implementation strategies for new survey and assessment products, as well as enhancements to existing products and services. With more than 9 years of experience in healthcare research and strategy, Amanda s experience includes a successful track record of new product launches and innovations, market research, brand management, strategic relationships, client management, as well as consulting and customer education. She received a Bachelor in Business Administration in management, marketing, and advertising from Indiana University. 12 HealthStream White Paper: The Survey Says A Snapshot of HealthStream s Pilot of the New Emergency Room Patient Experiences with Care Survey (ED-CAHPS)

13 209 10th Avenue South - Suite 450 Nashville, TN HEALTHSTREAM (NASDAQ: HSTM) HealthStream is a leading provider of workforce development and research solutions for providers throughout the continuum of care. We are dedicated to improving patient and resident outcomes through the development of healthcare organizations greatest asset: their people the professionals on the frontlines of care delivery every day. WP14EDCAHPS