Merit Based Incentive Programs 8/12/2016. Improving the Patient Service Experience in Preparing for MIPS

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1 Improving the Patient Service Experience in Preparing for MIPS Carlos Egea, MBA, MHA Chief Executive Officer, Administrator Northwest ENT & Allergy Center In January 2015, the Department of Health and Human Services announced new goals for Value Based Payments and APM s (Alternative Payment Models). Goal 1 30% of payments directly tied to Quality or Value by December 31, 2016 for APM s Category 3 & 4. Goal 2 85% of payments directly tied to Quality or Value by December 31, 2016 and 90% by the end of 2018 for APM s Category 2 4. Merit Based Incentive Programs To that goal, beginning in 2018, all present quality reporting programs (Meaningful Use, PQRS, CQM s, etc. ) will be replaced by MIPS which is comprised of 4 categories: Quality Resource Use Advancing Care Information 1

2 Merit Based Incentive Programs Each component of the program is weighted as follows: Quality = 50% Advancing Care Information = 25% = 15%** Resource Use/Cost = 10% 50% 25% 15% 10% Quality Advancing Care Info Clinicial Improvement Resource Use/ Cost Together, these four categories will comprise each providers Composite Performance Scores (CPS), and these scores in relation to the overall mean scores will determine whether a provider will receive: Reduction in payments No change in payments Increase in payments MIPS and Improving the Patient Experience The patient experience and more importantly, the patients impression of your practice and provider(s) is not only an important component of your CPS; It is a critical component in staying marketable and competitive in the era of online reviews and social media as a whole. The 15% of your CPS score impacted by addressing Clinical Practice can most definitely impact your reimbursements, but the damage to your practice from bad patient reviews easily accessible from multiple media formats, will definitely impact your overall profitability. 2

3 There are two main areas of focus within CPIA that specifically relate to improving the Patient Experience: 1. Expanded Practice Access** 2. Population Management 3. Care Coordination 4. Beneficiary Management** 5. Patient Safety and Practice Assessment 6. Participation in an APM Including a Medical Home Model Every provider will need to meet a combination of components within CPIA each year. According the CMS, clinicians will be able to choose the activities that best fit their practice. Year 1 All MIPS eligible clinicians or groups must designate response for activities on the CPIA Inventory with the administrative claims method being proposed to supplement CPIA submissions. Year 2 and beyond CMS is currently seeking public comment on two additional subcategories for future consideration and in future years MIPS eligible clinicians or groups and other relevant stakeholders may recommend activities for potential inclusion in the CPIA inventory. Each activity is worth a certain number of points based on the designation of weight (low, medium, or high). High Weight = 20 points Medium Weight = 10 points (Most activities fall within the medium weight category) 3

4 For maximum credit, the clinician or group, must achieve a total of through a combination of activities. There are special scoring considerations based on the size of the reporting group (individuals or groups with less than 15 providers) or for providers working in rural areas or areas designated as underserved where there is a geographical shortage of health professionals.* There are five specific proposed activities that are directly related to assessing patient experience and satisfaction. 1. Collections of patient experience and satisfaction data on access to care and development of an improvement plan, such as outlining steps for improving communications with patients to understanding of urgent access needs. (Medium weight = 10 points) 2. Collection and follow up on patient experience and satisfaction data on beneficiary engagement, including development of an improvement plan. (High weight = 20 points) 3.Regularly access the patient experience of care through surveys*, advisory councils and/or other mechanisms. (Medium weight = 10 points) 4.Measure and include quality and the practice and panel level that could include one or more of the following: (Medium weight = 10 points) a. Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice and at the level of the care team or MIPS eligible clinician or group 4

5 5. Adopt a formal model for quality improvement and create a culture in which all staff actively participated in improvement activities that could include one or more of the following: 1. Promote transparency and accelerate improvement by sharing practice level and panel level quality of care; patient experience and utilization data with staff, and/or 2. Promote transparency and engage patients and families by sharing practice level quality of care, patient experience and utilization data with patients and families. (Medium weight = 10 points) So how do you engage patients, collect data to meet CPIA requirements and improve the patient experience? Conducting a baseline service assessment examines how well you re serving your external and internal customers. Kevin W. Sullivan and Meryl D. Luallin How do your patients feel about the service experience in your practice? Do their impressions of the service experience meet or exceed the expectations and service goals of your organization? 5

6 A baseline service assessment/patient survey should focus on allowing the patient to evaluate every touch point in the service experience to include: 1. Appointments 2. Interaction with front office and clinical support staff 3. Perception of communication 4. Visit experience with the provider 5. Billing 6. Impressions of your facility 7. Overall patient satisfaction Appointments Areas to measure include: Ease of making their appointment Was an appointment available within a reasonable period of time Efficiency of the check in and registration Process Waiting time in the reception area Waiting time in the exam room Interaction with staff Areas to measure include: Courtesy of the person answering phones, scheduling appointments and/or answering clinical questions or taking requests for prescriptions Friendliness of the reception staff Keeping patients informed of delays Caring and concern of staff 6

7 Communication Areas to measure include: Was the patient s call answered promptly Was the communication clear and concise Where the patient s questions answered in a manner that was easy to understand Were educational materials provided and were they helpful/informative Were patients called back in a timely manner Were prescription refills easy to obtain as needed Was the staff helpful and compassionate to your needs during your call and/or visit Ease of use of the patient portal Ease of use of the practice website including access to forms, directions and maps, and information about providers and services Visit experience with the provider Areas to measure: Providers willingness to listen to you Taking time to answer questions Amount of time spent with the patient Explaining things in a way the patient could understand Provided instructions regarding medications/follow up care Knowledge of important information about the patients medical history Including the patient in decision making about the recommended treatment plan Billing Areas to measure include: Helpfulness of billing staff assisting the patient with billing and insurance issues Clarity of the billing statement Accuracy of the billing statement Promptness in resolving billing/insurance questions or problems. Courtesy and respectfulness of staff when dealing with sensitive financial issues 7

8 Convenience of hours of operation Overall comfort and cleanliness of the facility, waiting area, exam rooms and patient bathrooms Adequate Parking Signage and Directions Quality of entertainment and reading materials in waiting room and exam rooms Overall Patient Satisfaction Areas to measure include: Overall satisfaction with the practice The quality of medical care Overall satisfaction with the provider Would the patient recommend the providers to others? If not, then Why? It is critical to obtain as large of a survey sample from patients as possible to truly evaluate the perception of your practice from the patients perspective. Larger sample sizes provide a more accurate representation of the patient experience and will balance out the extreme outliers of patients who think you walk on water and those who will destroy you on sites like Yelp, Facebook, etc. 8

9 Methods of distributing the survey: Direct Mail average return rate for direct mail survey is less than 3% use survey sites like Survey Monkey to survey links to patients. Allows for electronic surveys and provides automated tracking and analytics to tally results. Biggest issue is having the end up as spam mail. Telephone surveys Having staff follow up with patients to conduct the survey via a phone call. This can be helpful but it is time consuming and difficult to manage best call times. Providing surveys to patients at Check Out Giving the patients the survey in a prestamped/pre addressed return envelope and asking them to provide the practice feedback on their experience. Mystery Shoppers Contacting patients prior to their visit and arranging for them to evaluate their experience with their visit without the staff knowing they are being reviewed. Once you have collected data, what s next? Identify the areas needing the most improvement or development Create a team of experts from within the practice to review the results of the surveys and to analyze the responses as follows: What areas of the patient experience were most people dissatisfied with? Are the issues identified rated to staff/physician interaction or process related? If the problems are process related, how can processes by simplified/streamlined for the patient(s)? If the problems are staff/physician related, how do you address it with each team member or physician, and how do you engage them in both accepting the criticism and creating solutions to improve their interactions with patients. Implementing Protocol Changes Based on the results of your patient survey s, assess each area of patient contact and implement protocol changes and improvements from the start of the patient experience to the end. Appointments/Patient Calls Look to streamline and improve how your team manages calls for: Scheduling appointments Assess staffing needs to create a dedicated scheduling team Consider on line automated scheduling options through your patient portal or secure website Outsource scheduling to a call service vendor/call center to provide 24 hour scheduling services Collecting patient information Assess your process for obtaining demographic and insurance information during a call Consider on line registration options through your patient portal or a support vendor to allow patients to selfregister Provide registration forms through the practice website for patients to complete prior to their office visit. Patients could print the forms or complete them via a PDF writer to then to your office via secure or vendor such as ShareFile. 9

10 Implementing Protocol Changes Interaction with front office and clinical staff and Perceptions of Communication Assess and address issues with: Communication between the staff and the patient with special emphasis on items such as: Presentation Friendliness of greeting, eye contact, professionalism Timeliness of response to patient questions Timeliness of processing prescription refills Consider implementing regular customer service training sessions for all team members including the opportunity to review patient survey s Create a Customer Service Action Committee made up of staff from the Front Office and Medical team to address patient concerns and implement protocols to improve communication skills Set reasonable deadlines for returning patient calls and completing requests for: Prescription Refills Physician Call Backs/Providing Results of Tests Inform patients of your practices policies and then measure how well your team adheres to those timelines Implementing Protocol Changes The patient s experience during their visit with the provider is the most critical area to address. Assess: Provider Communication How does the provider greet the patient when entering a room? Assess the provider s technique during the encounter looking at: Does the provider sit down and speak with the patient about their complaint/reason for their visit or do they start examining the patient while asking them questions? When the provider is documenting the patient record, do they have their back turned to the patient? Do they spend more time looking at their tablet than the patient? Would the use of a medical scribe benefit the provider by allowing them to focus on the patient while someone else documents the visit? Does the provider actively listen to the patient during the visit or do they talk at the patient? Does the provider take time to explain their findings or their recommendations for testing/treatment and give the patient the opportunity to ask questions? In a group setting, involve all providers in the discussion of how to improve their bed side manner. Physician to patient communication can be improved through the use of technology and support staff. Consider options such as an in office scribe or virtual scribe to allow the provider to focus on the patient. Implementing Protocol Changes Billing complaints are probably the most difficult items to address and resolve. In reviewing your survey s look at the following: Type of Complaint Are patients complaining about The amount charged for your services in general? The amount charged and the co insurance/deductible assigned for a specialty procedure (scopes, CT s, balloons, etc.)? Not being informed in advance of their personal financial responsibility? Not being presented with an option to deny a diagnostic service due to cost, such as a scope? The ability of your staff to explain how a claim was processed and why the patient has an outstanding balance? The courtesy of your billing staff? Pricing transparency? Your collections protocols? 10

11 Implementing Protocol Changes Based on the types of complaints and ratings regarding your billing practices, look at creating protocols for: Providing patients with financial estimates for co insurance/deductible amounts due for specific in office procedures Consider posting your pricing for services on your website or having a financial pricing sheet that could be presented to patients before expensive procedures are performed. Consider implementing a patient authorization for treatment for items not requiring authorization, such as scopes. Implement staff training protocols for addressing patient billing complaints and concerns and record patient calls for training and evaluation purposes Evaluate how to simplify your patient billing statements to make them easily understandable Create concise documentation policies for your team to ensure patient accounts reflect all communications to reduce misunderstandings. Create a detailed action plan to address the main areas of concern. Be sure to document the changes in processes/behavior and actively engage all practice staff in implementing the changes. Follow Up Don t assume that because you have addressed the issues brought up through the survey that the job is done. Actively monitor all key areas of concern through: Focused periodic survey s Survey patient s on the specific areas identified in the initial survey to see if their experience has improved. Mystery Patients Continue to have new mystery patients conduct assessments of the practice as a whole to see if their perceptions are similar to your baseline group or reflect the improvements/changes implemented as a result of the items identified in the baseline survey. Provide feedback to your teams On average, it takes a minimum of 30 days of consistently reinforcing changed behaviors for them to become the new normal. Provide regular updates to all teams on the feedback received from patients, so that they can assess their own success. Course Correct Adjust your processes and behaviors as needed. While you may think that your initial plans will work perfectly, the reality is that patient perceptions are fluid and fickle. Constantly make course corrections to your plan of action to ensure that you tackle problems as they arise. Improving the Patient Experience Medicine is more than ever a consumer driven industry. By focusing on providing high quality care along with a high quality experience, providers can meet the regulatory requirements to sustain or increase their reimbursements while attracting more patients. Accepting and addressing the concerns of your patients will help your team sustain long term success. 11

12 References Initiatives Patient Assessment Instruments/Value Based Programs/MACRA MIPS and APMs/Quality Payment Program.html MIPS training Performance Category MIPS Scoring Methodology Overview Federal Register, Vol. 81, No. 89/Monday May 9, 2016, Proposed Rules, pages MGMA Advocacy: The MIPS/APM Proposed Rule and the Future of Medicare Value Based Payment, January 2016 Star Studded Service: 6 Steps to Winning Patient Satisfaction, 2 nd edition, Kevin W. Sullivan, Meryl D. Luallin 12