Improvement in HHCAHPS Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc. healthcareprovidersolutions.com Measures Affecting Star Ratings VBP - HHCAHPS Measures Source Home Health Compare Communication HHCAHPS Star Rating Care of Patients HHCAHPS Specific Care Issues HHCAHPS Overall Rating HHCAHPS Would Definitely Recommend HHCAHPS 1
HHCAHPS Star Ratings CMS published the first round of HHCAHPS Star Ratings in January 2016 The data posted in January included surveys administered for the sample months of July 2014 to June 2015 HHAs must have at least 40 completed surveys over the four-quarter reporting period to receive HHCAHPS Star Ratings Four of the five publicly reported HHCAHPS measures are included in the Star Rating calculation: The three HHCAHPS composite measures are: Care of Patients (Q9, Q16, Q19, and Q24) Communication Between Providers and Patients (Q2, Q15, Q17, Q18, Q22, and Q23) Specific Care Issues (Q3, Q4, Q5, Q10, Q12, Q13, and Q14) The HHCAHPS Global Item is: Overall Rating of Care Provided by the Home Health Agency (Q20) Each of these measures is individually rated, and a Summary rating is also provided Linearized Scoring The HHCAHPS Star Rating calculation uses a very different methodology called Linearized Scoring Individual survey responses are converted into linear scores on a 0-to-100 point scale Example: Score 0: 0 x 0 = 0 Score 1: 0 x 10 = 0 Score 2: 0 x 20 = 0 Score 3: 0 x 30 = 0 Score 4: 0 x 40 = 0 Score 5: 0 x 50 = 0 Score 6: 1 x 60 = 60 Score 7: 1 x 70 = 70 Score 8: 6 x 80 = 480 Score 9: 9 x 90 = 810 Score 10: 33 x 100 = 3,300 Total Score: 4,720 Linearized Score: 4,720 / 50 responses = 94.4% Source: Strategic Healthcare Programs 2
Driving Improvement with Staff 1 Know the HHCAHPS Survey Institute a practice to have agency staff periodically read the survey so that the questions stay fresh in their mind, and they are reminded of how the perception of their care and performance is being measured by the patient. Agency success relies, in part, on the ability of agency staff to deliver quality care and explain care delivery using the actual language found on the survey. 2 Know what is NOT ALLOWED by CMS for agency staff to do See following 3 screens 3 Focus improvement on the publicly reported scores HHCAHPS publicly reported scores include one global question and three composite measures. Because the composites are comprised of other survey questions, by focusing on them, you will automatically be considering the multiple facets of the satisfaction equation. Information for Patients Because home health patients may be sicker and more vulnerable than other patient populations and they receive care from the home health provider in their homes, they may be more susceptible to actions that may influence their responses to the HHCAHPS Survey. Any information or communication about the survey from HHAs may introduce bias to the survey. It is acceptable for HHAs to inform patients during their next scheduled assessment that they may be asked to respond to a patient experience survey as long as all patients are notified in this way. 3
Information for Patients It is not acceptable, however, for an HHA to do the following: Mail or e-mail information to patients in advance alerting them about the survey, other than the information provided to all patients; Provide a copy of the HHCAHPS Survey questionnaire or cover letters to the patients; Include words or phrases verbatim from the HHCAHPS Survey in its marketing or promotional materials (CMS is encouraging HHAs not to use text from HHCAHPS questions in their marketing and promotional materials); Attempt to influence their patients answers to the HHCAHPS Survey questions; Information for Patients Tell the patients that the agency hopes or expects that its patients will give it the best or highest rating or to respond in a certain way to the survey questions; Offer incentives of any kind to the patients for participating (or not) in the survey; Help the patient answer the survey questions, even if the patient asks for the home care provider s help; Ask patients why they gave a certain response or rating to any of the HHCAHPS Survey questions; and Include any messages or materials promoting the HHA or the services it provides in survey materials, including mail survey cover letters and questionnaires and telephone interview scripts. 4
Key Questions Care of Patients 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 the home health providers from this agency treat you as gently as possible? Q19 In the last 2 months of care, how often did the 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? Key Questions Care of Patients How many caregivers has the patient had? Case conferences effective? Is the patient asked what another clinician may or may not have done on previous visits? Are clinicians proactive about the patient feeling like they are the only patient that clinician treats? Does the patient know they are not just a medical record number? Do you have clinicians that are not courteous or respectful to supervisors or co-workers? Do you follow-up on every complaint? Do you hold clinicians accountable? 5
Key Questions Communications 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? 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? 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? Key Questions Communications Q18 - In the last 2 months of care, how often did home health providers from this agency listen carefully to you? 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? 6
Key Questions Communications Do you know you have OUTSTANDING SOC/Admissions staff that understanding the importance of getting started on the right foot and spend the time with patient? Do your field staff call ahead of time on visit day? Do you have constant schedule changes and rescheduling of visits and do you make patients aware when this is necessary? Do you have staff that you consider to be patient and good listeners and provide education and training that is understandable? What is the protocol for taking patient phone calls, including mandated response time to requests? Key Questions Specific Care Issues 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 and over-the-counter 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 and overthe-counter medicines you were taking? 7
Key Questions Specific Care Issues 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 side effects of these medicines? Key Questions Specific Care Issues What is the medication review policy in your agency? Do therapists conduct SOC/Comprehensive assessments and if so, do they follow the medication review policy? Do you automatically request orders to teach new and/or changed medications if you don t already have those orders? Are clinicians truly spending time reviewing and getting feedback from patients or just distributing paperwork regarding medications? What are agency pain assessment protocols and more importantly the implementation of improvement in pain, if exists? 8
Key Questions Global Item Q20 - We want to know your rating of your care from this agency s home health providers. Using any number from 0 to 10, where 0 is the worst home health care possible and 10 is the best home health care possible, what number would you use to rate your care from this agency s home health providers? Key Questions Global Do we know how our patients feel about us? Do we conduct our own surveys of sorts? Do your patients truly feel that you are a 10? Do you feel that you are a 10? You treat a disease, you win, you lose. You treat a person, I guarantee you, you ll win, no matter what the outcome. - Patch Adams They may forget your name, but they will never forget how you made them feel. - Maya Angelou 9
Outstanding Service Outstanding service is not the norm. Outstanding service allows the patient to be at the center of the decision. Outstanding service is about how we do what we do. Outstanding service results from education and training. Outstanding service makes a difference in patient care and patient satisfaction. The HEAT Model Hear them out! Allow them to blow their stack (venting, externalization). Paraphrase as they share their story. Let me see if I understand Sometimes this will lead to more comments, not less. You want them to vent and get everything out only then will they switch back to being more reasonable. Empathize with their situation! Once they are done, show genuine empathy. Instead of saying I understand, try using language that s a little less used and worn. No wonder you called, You re right, this is a problem, and You have every right to be upset, are examples we hear from experienced professionals, who know how to handle customers and put them at ease. 10
The HEAT Model Ask more detailed questions if necessary! Say, I m going to do everything I can to help. To do that I need just a few more details, is that okay? If they say No or continue complaining, just go back to H and E. If they say Okay, proceed to ask whatever details you require. Take action, if action is required! Be careful not to overcommit! Sometimes a service professional is so relieved to get to this point with the customer they are tempted to promise whatever the customer wants. That could be a mistake and lead to another blow up session tomorrow. Improving Agency Scores Share your results Engage your staff in improvement all staff! Be deliberate and focused Be specific Develop standards, scripts and behaviors Don t forget identifying processes that create problems & correct them Call patient s family after admission and periodically Hold managers and staff accountable 11
Data Offers Insight Data by patient: Risk assessments provide useful data point(s) to help deliver consistent, predictable care and best outcomes Track individuals in real time for data correction or course correction Identifies which patients for investigating outcomes Are we sure patients are happy with our services and understand the importance of the HHCAHPS surveys? Agency Questions Do we have the right vendor? Do you utilize the right method for our patients: 1) Mailed Surveys 2) Phone Call Surveys Does the agency conduct their own surveys? Do staff members have a plan to ensure the patient knows about the survey? 12
Melinda A. Gaboury, COS-C Chief Executive Officer Healthcare Provider Solutions, Inc. 810 Royal Parkway, Suite 200 Nashville, TN 37214 615.399.7499 615.399.7790 info@healthcareprovidersolutions.com www.healthcareprovidersolutions.com 13