CAHPS Focus on Improvement The Changing Landscape of Health Care. Ann H. Corba Patient Experience Advisor Press Ganey Associates

Transcription

1 CAHPS Focus on Improvement The Changing Landscape of Health Care Ann H. Corba Patient Experience Advisor Press Ganey Associates

2 How we will spend our time together Current CAHPS Surveys New CAHPS Surveys How to Prepare / Best Practices 2

3 CMS Patient Experience Requirements Medicare Advantage Health Plans (MA CAHPS) Prescription Drug Plan (PD CAHPS) Hospitals (HCAHPS) Home Health Agencies (HH-CAHPS) Accountable Care Organizations (ACO CGCAHPS) Large Medical Groups (PQRS CGCAHPS) 3

4 Future CAHPS Surveys Dialysis Centers ICH CAHPS Implementation Hospice Providers Hospice CAHPS Survey Development Hospice CAHPS Implementation Emergency Departments ED CAHPS Survey Development ED CAHPS Implementation Hospital Outpatient Departments Ambulatory Surgery Centers Outpatient Surgery CAHPS Survey Development Outpatient Surgery CAHPS Survey Development OS CAHPS Implementation OS CAHPS Implementation 4

5 ED CAHPS Possibly tied to Outpatient Prospective Payment System as part of the Outpatient Quality Reporting Program Survey being developed by RAND Corporation Field test based on November 2013, December 2013, and January 2014 visits Multiple survey versions being tested Discharged from ED Discharged from Inpatient and not selected for HCAHPS Discharged from Inpatient and included on HCAHPS survey Mail or telephone data collection 5

6 OS CAHPS Possibly tied to Outpatient Prospective Payment System as part of the Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Reporting Program Survey development by RTI Field test to begin in Spring 2014 Test will include hospital outpatient departments and ambulatory surgery centers - one survey being created to measure both settings Data collection will be stratified to ensure representation from four groups of procedures: Ophthalmology, Orthopedics, Gastrointestinal, and all others 6

7 Additional Surveys Under Discussion Inpatient Psychiatric Facilities Long Term Care Hospitals Inpatient Rehabilitation Pediatric HCAHPS 7

8 Hospital Consumer Assessment of Healthcare Providers & Systems HCAHPS

9 Current Patient Eligibility Client Exclusions: Patients who die while in the hospital Documented No Publicity patients Newborns Other patients excluded by law in your state Press Ganey Exclusions: Patients admitted and discharged on the same day Patients under 18 at admission Patients with an ineligible MS-DRG Patients with an international address Patients admitted from or discharged to a correctional facility Patients discharged to hospice care Patients discharged to a nursing home or skilled nursing facility 9

10 Survey Restrictions Patients cannot be surveyed during hospitalization or at discharge Patients can be asked about their stay when the focus is on the clinical care *CMS CAHPS Hospital Quality Assurance Guidelines V7 10

11 Communication Guidelines Hospitals SHOULD Encourage response to the survey It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge. Improve the patient experience Distribute the communication guidelines Hospitals SHOULD NOT Ask patients for a certain score Indicate that their goal is to receive a certain score Show the HCAHPS survey or cover letter to the patient prior to survey administration Mail pre-notification letter or postcards Distribute in-house surveys to Inpatients 2013 Press Ganey Associates, Inc 11

12 Hospital Value-Based Purchasing (VBP) Required as part of the Affordable Care Act Achievement How well you perform compared to peers Improvement How much you have improved 2013 Press Ganey Associates, Inc 12

13 Key elements of VBP Zero sum game Incentive pool funded by withhold of portion of baseline DRG payment (not the annual payment update) across all patients. Hospital earns back a percentage of what is withheld, based on performance on Clinical Quality and Satisfaction measures (FFY13) Measures selected from those now used for public reporting and the Medicare APU Each measure scored on Achievement and Improvement, the higher of which is used in overall score calculation 2013 Press Ganey Associates, Inc 13

14 Hospitals Subject to Inpatient VBP General acute care hospitals paid by IPPS (inpatient prospective payment system) Excluded Critical Access Hospitals Children s and Specialty Hospitals Hospitals that lost APU under IQR reporting Base DRG Reimbursement at Risk % of payment % % % % 2013 Press Ganey Associates, Inc 14

15 Domain Weighting for FFY15 15

16 HCAHPS Results

17 17 HCAHPS Data

18 18 HCAHPS Data

19 19 HCAHPS Data

20 HCAHPS Data 20

21 HCAHPS Data 21

22 Attaining High HCAHPS Percentile Rank Becomes More Challenging Each Year Since 2008, performance across US hospitals has improved significantly Average market performance on HCAHPS increased ~10% from Jan 2008 to Jan The entire distribution has shifted to the right and is tighter. You have to work harder just to maintain rank. Rank you would earn if 75% of your patients rated your hospital a 9 or 10 88th th 81st 78th Source: CMS Data. 22

23 % Top Box Inpatients Admitted Through the ED Give Lower Scores - Across Every HCAHPS Domain The tight national distribution means that small % Top Box differences can drive large differences in national rank. Doctor Communication: 85.6% Top Box 83 rd percentile 76.7% Top Box 19 th percentile Inpatient Scores on HCAHPS Survey Admitted through ED Other Inpatients Nurse Responsive Physician Clean Quiet Pain Medication Discharge Rate Recommend Source: Press Ganey Data, July 2012-Dec

24 How to Prepare

25 A 5-Step Plan for Preparation The 5 Stages of Grief Depression Acceptance Bargaining Anger Denial 25

26 The Triple Aim Improve the health of the defined population Enhance the patient care experience (including quality, access and reliability) Reduce, or at least control, the per capita cost of care Better health for populations Better care for individuals Lower cost through improvement 26

27 Press Ganey Approach 27

28 A Recipe for Success A 5 Step Process Building A Strong Foundation Prioritizing for Improvement Voice of the Patient Early Adoption of Survey Tool Education & Training 28

29 5 Step Process Building A Strong Foundation 29

30 Step #1 Building a Strong Foundation: Culture We Know That A Strong Foundation is Critical Vision Leadership Engagement Employee Partnership Transparency and Trust Accountability Organizational Culture that Supports Improvement 30

31 Step #1 Building a Strong Foundation: Culture Every employee understands: Vision What we want to achieve How we will achieve it What it looks like when we arrive How we will sustain & continue to evolve 31

32 Step #1 Building a Strong Foundation: Culture Leaders are : Leadership Engagement Walking the talk Engaging staff in discussions Motivating & empowering staff to own change Breaking barriers Holding everyone accountable 32

33 Step #1 Building a Strong Foundation: Culture Employees are : Employee Partnership Engaging in discussions to bring about change Holding each other accountable Looking for solutions Collaborating vs. acting in silos 33

34 Step #1 Building a Strong Foundation: Culture Collectively, the organization is: Transparency & Trust Having open & honest communication Looking for joint solutions Collaborating 34

35 Step #1 Building a Strong Foundation: Culture If you can t measure it, you can t fix it! Accountability Holding each other accountable for: Standards of Behavior Effectiveness Efficiency 35

36 Step #1 Building a Strong Foundation: Structure Evaluate for Organizational Structure Volume based vs. Value based Leadership & cultural relationships Hospital governance structure Patient advocates/champions Goal alignment Information sharing Moving from case management to continuum of care Collaborative care Degree of emotional intelligence 36

37 Step #1 Building a Strong Foundation: Structure Physician Partners Physician involvement is needed Peer to peer respect Understand the challenges and unique perspectives Can assist with engagement Peer to peer reviews/mentoring Compensation models 37

38 Partnering Service Excellence & Quality Functions Every point in healthcare has potential to result in service failure Service product Setting Delivery system Staff Patients put off by healthcare organizations unresponsive to service recovery Improvements in service quality: Reduces costs Boosts morale Provides better patient experience Doing the right thing, at the right time, for the right person, and having the best quality result outcome. AHRQ Frottler, M (2009). R Ford, C Heaton. Chicago, IL: Health Administration Press. pp

39 5 Step Process Building A Strong Foundation Prioritizing for Improvement 39

40 Rising Tide Measure: Nurse Communication This cluster of measures makes up 15% of a hospital s VBP score 40

41 Step #2: Prioritizing for Improvement Goal: To reduce suffering and concerns not increasing happiness 41

42 Step #2: Prioritizing for Improvement Miscommunication: Happens More Than We Think Effective Communication What is your message is conveying? Uniformity of information Moving patients from treatment to prevention mindset W 3 What are you doing? Why are you doing it? What s the impact on me/ what does it mean for my care? 42

43 What is Your Message? How You Communicate Is As Important as What You Say! Body 55% Language 7% Verbal 38% Intonation Source: An Introduction to Interpersonal Communication 43

44 5 Step Process Building A Strong Foundation Prioritizing for Improvement Voice of the Patient 44

45 Step #3: Voice of the Patient 45

46 Step #3: Voice of the Patient We Know That COMMENTS are the true voice of the healthcare experience Powerful written messages Suggestions can help identify and drive improvement Can help create buy-in with front-line staff on changes that may need to be made 46

47 Census-Based Surveying: Capturing the Voice of Every Patient 47

48 National Best Practices Nurse Hourly Rounding Discharge Phone Calls Quiet Campaigns Leader Rounding White Boards Service Recovery Daily Huddles Employee Recognition 2013 Press Ganey Associates, Inc 48

49 Hospital Best Practices Hourly Rounding 49

50 Hospital Best Practices Nurse Leader Rounding 50

51 What Gets Measured, Gets Done Every initiative needs: Communication plan for staff and patients Implementation Schedule Metrics to measure progress Regular (monthly/weekly) distribution of metrics - make adjustments if necessary A way to track staff/leaders understanding and successful completion of initiative 2013 Press Ganey Associates, Inc 51

52 5 Step Process Building A Strong Foundation Prioritizing for Improvement Voice of the Patient Early Adoption of Survey Tool 52

53 Step #4: Institute an Early Adoption Mindset We Know That Early Adopters are Higher Performers 53

54 1/1/2011 2/1/2011 3/1/2011 4/1/2011 5/1/2011 6/1/2011 7/1/2011 8/1/2011 9/1/ /1/ /1/ /1/2011 1/1/2012 2/1/2012 3/1/2012 4/1/2012 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/ /1/ /1/ /1/2012 1/1/2013 2/1/2013 3/1/2013 4/1/2013 5/1/2013 6/1/2013 7/1/2013 8/1/2013 9/1/2013 Medical Practices Preparing for P4P Since 2010, Press Ganey clients have been using the CGCAHPS visit specific survey to prepare for compliance and identify areas needing improvement. 8,648 sites, 42,611 Providers Seeking ways to understand, monitor, and act to improve CGCAHPS results before public reporting and regulatory requirements Benchmarking against other first-movers/top performers The Press Ganey Early Adopter Community has put those in the database ahead of the curve and continues to grow 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Press Ganey CGCAHPS Early Adopter Database Nearing 45,000 Providers and 9,000 Sites. 42,611 8,648 sites providers 54

55 5 Steps to Success Building A Strong Foundation Prioritizing for Improvement Voice of the Patient Early Adoption of Survey Tool Education & Training 55

56 Step #5 Education & Training Learn Today, Improve Tomorrow Clinical outcomes are linked to how well providers communicate Patient centered care depends on patient engagement Understand the patient s fears, ideas and expectations Ensure the patient/family feels invited to express concerns during time together 56

57 Step #5 Education & Training Lower Malpractice Costs 1 Physicians ranked in the lowest 1/3 of the Press Ganey database were 110% more likely to have malpractice suits brought against them than those with top satisfaction survey ratings. Lower Readmission Rates 2 Higher overall patient satisfaction associated with lower 30-day risk-standardized hospital readmission rates after adjusting for clinical quality (AMI, HF, PN). Improved Patient Compliance 3 Overall satisfaction is positively correlated with clinical adherence to treatment guidelines 1. American Journal of Medicine : Am J Manag Care. 2011;17(1): N Engl J Med. 2008; 359:

58 Learn Today, Improve Tomorrow What can you do differently tomorrow? How to sustain change - Brain needs 8 16 repetitions to learn - 21 days to make or break a habit - 10 weeks of consistent practice - You get the behavior you reward. 21 DAYS! Stay focused on what you want! 58

59 Education is the most powerful weapon which you can use to change the world -Nelson Mandela Thank you!