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I. HH-CAHPS Overview Survey Design and Process Public Reporting Part II.

1 Making HHCAHPS Easy! Understanding HHCAHPS and Using it to Your Advantage Home Care Alliance of Massachusetts 2010 Spring Conference Cathy King National Director of Business Development Today s Agenda Part I. HH-CAHPS Overview Survey Design and Process Public Reporting Part II. Tips on Choosing a Vendor Common Pricing Models Agency Preparation Tips About Deyta Specialists in home health and hospice satisfaction Administering satisfaction surveys since 1993 Currently work with over 2,000 home health and hospice agencies, and growing CMS approved for HHCAHPS Satisfaction Technology Platform Scalable, effectively supporting multi-site organizations Sophisticated system, simple to use Largest satisfaction benchmarks in the nation 1

2 Benefits of Using Deyta We re specialists in home health satisfaction We understand your challenges Experts in satisfaction data collection Operational, business centric approach Month of service reports Multi-level benchmarking structure Ad Hoc reporting Dedicated client service team We make implementation easy Ongoing training on results interpretation Value based pricing model for HHCAHPS CMS required second wave mailing is included All reporting and comments are included HHCAHPS Overview What is Home Health Care CAHPS What is CAHPS? Consumer Assessment of Healthcare Providers and Systems Standardized national survey for home health patients Measures patient perception of care Component of Home Health Quality Initiative Changing focus from quantity to quality 2

3 CMS Objectives with HHCAHPS Produce comparable data Create incentives for agencies to improve quality Enhance public accountability What is HHCAHPS Measuring Perception of the clinician s ability to deliver Details on home care services, visits and timing Safety and falls prevention Medication instructions Pain management Sensitivity to patient needs Courtesy and respect Listening Perception of the HHA s responsiveness HHCAHPS Program Highlights Final Rule HH PPS CY2010 Medicare-certified agencies CMS mandates use of approved survey vendor Results will be publically reported on HHC Only Medicare and/or Medicaid patients For CMS data reporting Many HHA s surveying all patients for accurate results 3

4 HHCAHPS Program Highlights Must meet two requirements starting in 2010 or receive a 2% reduction in reimbursement starting in CY 2012 Conduct Dry Run in Q Continuously collect HHCAHPS survey data as of 10/1/2010 Qualifies for full market basket update in CY2012 Participation Exemptions Less than 60 survey eligible patients per year Exemption form on Form completed by 6/16/2010 Provide patient count from 4/1/09 3/31/10 Unduplicated patients Exempt from data collection from Q Q Annual exemption reporting needed Participation Exemptions Medicare-certified on or after 4/1/2011 for payments to be made in CY2012 Should begin process as soon as possible A reconsideration and appeals process being developed Details in CY 2012 HH payment rule 4

Free Information Survey Design and Process Survey

tool Questions 1-25 always asked first Questions 26-34

Deyta Satisfaction Process Measures Includes satisfaction

5 Free Information Survey Design and Process Survey Instrument Standard set of questions 35 question survey tool Questions 1-25 always asked first Questions About You - demographic Supplementary questions (optional) Deyta Satisfaction Process Measures Includes satisfaction for all Visit types and Disciplines Best practice of most successful agencies 5

The HHCAHPS Survey Tool Patient Eligibility Criteria Monthly random sample of patients:

sample frame is drawn Current or discharged who had at least one skilled visit during

receiving hospice Not recently surveyed (during 5 months prior) Not requested no

Agency sends monthly data file to CMS Approved Survey Vendor 3.

6 The HHCAHPS Survey Tool Patient Eligibility Criteria Monthly random sample of patients: Medicare and/or Medicaid (for minimum compliance) At least 18 yrs Are not deceased when sample frame is drawn Current or discharged who had at least one skilled visit during sample month At least two skilled visits in 60 day look back period No maternity care Not receiving hospice Not recently surveyed (during 5 months prior) Not requested no publicity status Survey Process 1. Agency sends monthly data file to CMS Approved Survey Vendor 3. Vendor compiles results and submits data to CMS HHCAHPS Process 2. Vendor determines eligible patients, conducts sampling and distributes survey 4. Monthly reporting of results on to HHA 6

7 Monthly Data File Patient-level data elements submitted monthly to vendor Required data elements OASIS Visit/Transaction it/t ti records Patient Information/Demos Survey Cycle Random sampling and survey distribution Timing of Survey Distribution Distributed at the beginning of the month Surveys received by patient within 3 weeks Second wave of surveys if no response se in first 3 weeks Six week field period allowed from the first date surveys were mailed HHCAHPS surveys received after the cut off period will not be reported to CMS Data Collection Mode Survey data can be collected using one of three data collection modes: Mail Telephone Mixed mode (mail with telephone follow-up) Estimates of Response Rates Associated with Similar Surveys per CMS Mode Response Rate Sample size for 25 responses/month Mail Only 30% 84 Phone Only 35% 72 Mixed 40% 63 7

Managing the Sample HHA s should target 300 completed surveys per year Smooth inflow of completed surveys during course of the year Monthly sampling protocols Automatically adjust the random sample

needed to maintain the goal of 300 returns per year per CCN. Set n = maximum between this value and the goal for that CCN. The data k will be split into mutually exclusive sets.

8 Managing the Sample HHA s should target 300 completed surveys per year Smooth inflow of completed surveys during course of the year Monthly sampling protocols Automatically adjust the random sample size to generate the new monthly requirement If patient count will not reach 300, then survey 100% of patients Proportionate Random Sampling Deyta will first determine the minimum number of records needed to maintain the goal of 300 returns per year per CCN. Set n = maximum between this value and the goal for that CCN. The data k will be split into mutually exclusive sets. For each download we will determine for i=1 to k N = the number of patients for the CCN submitted N = the number of patients to sample for the CCN N = the number of patients in the ith strata the sum Ni = N pi = the proportion of patients in the ith strata pi = Ni / N and sum pi = 1 Ni = N * pi we will round up to be conservative on the sample size. Thus sum Ni>= N Patient Confidentiality 3/9/10 Addendum to P&G Manual Chapter VIII CMS has decided to allow survey vendors to share information that could link an HHCAHPS respondent to his or her answers under one condition only: survey vendors can share a respondent s survey responses linked to his or her name with the client HHA only if the patient (hereafter referred to in this document as the respondent) gives the survey vendor permission to do so. A Completed Survey Definition of a Completed Survey A survey is considered to be complete if at least 50 % of the questions applicable to all sample members (Questions 1 11, 15 21, and 24 25) are answered. Skip pattern and About You items are not included in this calculation Exhibit 9.1 Steps for Determining if a Questionnaire Meets Completeness Criteria Sum the number of questions that have been answered by the respondent that are applicable to all patients. These include questions 1 11, 15 21, and R = total number of questions answered Divide the total number of questions answered by 20, which is the total number of questions applicable to all patients, and then multiply by 100 to determine the percent. Percentage Complete = (R 20 ) 100 If the Percentage Complete is greater than or equal to 50%, then assign the applicable survey completed disposition code (code 110 or 120) to indicate that the case meets the definition of a completed survey. Otherwise, assign the disposition code for break off (code 310) to the case. 8

9 Public Reporting Measures for Public Reporting 2 Global Measures Overall rating of home health care (0-10) Would recommend the HHA (yes/no) 3 Composite Measures Care of patients Communication between providers and patients Specific care issues (medicines, pain, safety) Global Question - Overall Rating of Care Using a number from 0 to 10 0 is the worst home health care possible 10 is the best home health care possible 9

10 Global Question - Agency Recommendation Would you recommend this agency to family/friends in need of home health care? Definitely yes Probably yes Probably no Definitely no Care of Patients Composite HHCAHPS Question Response Scale Q9. In the last 2 months of care, how often did home health providers from this agency seem informed and up-to-date about all the care or treatment you got at home? Q16. In the last 2 months of care, how often did home health providers from this agency treat you as gently as possible? Never, Sometimes, Usually, Always Never, Sometimes, Usually, Always Q19. In the last 2 months of care, how often did home health providers from this agency treat you with courtesy and respect? Q24. In the last 2 months of care, did you have any problems with the care you got through this agency? Never, Sometimes, Usually, Always Communications Between Providers/Patients Composite HHCAHPS Question Q2. When you first started getting home health care from this agency, did someone from the agency tell you what care and services you would get? Response Scale Never, Sometimes, Usually, Always Q15. In the last 2 months of care, how often did home health providers from this agency keep you informed about when they would arrive at your home? Never, Sometimes, Usually, Always Q17. In the last 2 months of care, how often did home health providers from this agency explain things in a way that was easy to understand? Q18. In the last 2 months of care, how often did home health providers from this agency listen carefully to you? Never, Sometimes, Usually, Always Never, Sometimes, Usually, Always Q22. In the last 2 months of care, when you contacted this agency s office did you get the help or advice you needed? Q23. When you contacted this agency s office, how long did it take for you to get the help or advice you needed? Same day, 1 to 5 days, 6 to 14 days, More than 14 days 10

11 Specific Care Issues Composite HHCAHPS Question Q3. When you first started getting home health care from this agency, did someone from the agency talk with you about how to set up your home so you can move around safely? Q4. When you started getting home health care from this agency, did someone from the agency talk with you about all the prescription medicines you were taking? Q5. When you started getting home health care from this agency, did someone from the agency ask to see all the prescription medicines you were taking? Q10. In the last 2 months of care, did you and a home health provider from this agency talk about pain? Q12. In the last 2 months of care, did home health providers from this agency talk with you about the purpose for taking your new or changed prescription medicines? Q13. In the last 2 months of care, did home health providers from this agency talk with you about when to take these medicines? Q14. In the last 2 months of care, did home health providers from this agency talk with you about the important side effects of these medicines? Response Scale Patient Characteristics: About You Health status Age Sex Living Situation Education Race Language Help completing the survey Public Reporting Details Only HHCAHPS survey items will be reported Reported results will be based on a rolling 12 months (four quarters of data) Updated each quarter Begin in spring 2011 Review period before public reporting each quarter Dry Run data not reported 11

12 Choosing A Vendor Tips Tips on Choosing a Vendor? 1. CMS Approved 2. What is their experience in home health and satisfaction? How long have they been doing this? Long term viability? Trust them to ensure you comply with regs? Supplemental questions for useful information? Tips on Choosing a Vendor? 3. Entry-level product or complete solution? 4. Reporting What is included Usefulness Frequency 5. Comments included Handle anonymous patient comments Alerts Online reporting by branch/team Monthly reporting 12

13 Tips on Choosing a Vendor 6. Dedicated support Implementation and data delivery CMS management Report analysis 7. Ability to handle sampling and patient protocols Data cleansing and patient selection Ongoing compliance algorithms Simultaneous surveys Tips on Choosing a Vendor 8. Pricing Consideration What is pricing model and components? What data collection mode do you offer? What is included in the base pricing? Does it cost more for comment reporting? What type of reports are included? Does it cost more for dedicated service? Is there a data fee? Custom reports? Common Pricing Models 13

14 Pricing Models Pay per Patient License fee Fee per patient Includes second wave mailings, reporting (comments) data support, guarantee CMS compliance, dedicated customer service Example 1 agency (CCN) with 1000 patients per year $500 (Base Fee) $3 per patient Total Cost: $500 + ($3 * 1000) = $ 3,500 Pricing Models Pay per Survey License fee Per survey fee Dependant on response rate. Charges for comments and custom reports. Example 1000 patients $500 base fee $2.45 per survey and 80% second wave mailing Total Cost: $4,910 $500 + (1000 * $2.45)+(1000*.80*$2.45) Pricing Models Compliance Pricing Pricing per provider number All Inclusive of second wave mailings Based on number of patients Billed up front for the year or monthly at your request Contract term 24 months Annual Patients Surveyed Standard Annual Fee HCAM Members Annual Fee (10% discount) $1,200 $1, $2,100 $1, $3,300 $2, $4,500 $4,050 14

15 Agency Preparation Tips Agency Preparation Tips Education team on HHCAHPS Define expectations of team Build communication skills Language challenges with patient Familiarize with HHCAHPS questions Set and review satisfaction goals Locations Teams Disciplines Timeframes Agency Preparation Tips Teach and foster customer centric approach Develop service training programs Tie customer centric behaviors to performance Goals, Incentives, Evaluations Feedback Orientation Revise corporate scorecards or incentive programs Create HHCAHPS task force Multi disciplined 15

16 Agency Preparation Tips Build HHCAHPS survey into orientation and training Identify improvement initiatives and revise systems Update admissions information Advise patient to expect survey Build pro-active partnership with patient Tell Me if my care is not exceeding expectations Exceptional clinical notation of communication issues Helps set expectations for all visits Additional Resources Home Health Care CAHPS Survey informational web site Federal Register HHPPS CY 2010 Final Rule NQF Endorsement of New Quality and Patient Experience Standards d in Home Health Care Agency for Healthcare Research Quality Thanks for Listening!!! Got Questions Want Clarification Need Vendor Cathy King National Director of Business Development e: cking@deyta.com p:

Introduction to the Home Health Care CAHPS Survey Webinar Training Session. Session I. January 2018

Introduction to the Home Health Care CAHPS Survey Webinar Training Session Session I January 2018 Session I 2 Introduction to the Home Health Care CAHPS Survey Welcome This training session will cover