HCAHPS results are playing an increasingly larger role in the financial well-being of America’s hospitals.
Since 2007, CMS has required most hospitals to submit HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), a standardized survey tool to measure patient perception of the quality of care received, or face payment reductions. However, beginning in its fiscal year 2013, it will move from a pay-for-reporting system to one based on pay-for-performance. That’s when CMS implements its value-based purchasing program, which will reward and penalize hospitals for performance on certain indicators, including certain HCAHPS measures.
Under the proposed value-based purchasing rule, 30 percent of each hospital's total performance score would be based on patient experience indicators as determined by HCAHPS. In the first year, the other 70 percent of the score would be based on 17 core process measures.
However, some have suggested that this weighting creates too much of a focus on patient experience as opposed to clinical outcomes. The American Hospital Association, for example, recently asked CMS to reduce this weighting to 15 percent.
But Quint Studer, founder and CEO of Studer Group, says HCAHPS results and quality are actually two sides of the same coin.
HCAHPS link to quality
Mr. Studer says the HCAHPS survey not only provides an accurate reflection of the quality of care provided but also gives hospitals a sense of how well they are performing their mission.
While it’s true that HCAHPS measures patient perception of quality, many of the results also directly connect to actual quality. Measures on whether patients received information about which medications they are taking and whether they received discharge instructions are two prime examples, says Mr. Studer.
By making sure patients take their medications properly and that they do the right things after they leave the hospital, care providers make it more likely that patients will stay safe and heal faster, he says.
HCHAPS results are also a useful tool in helping hospitals assess whether they are performing in line with their missions.
"I've never met a mission statement — at for-profit and non-profit hospitals alike — that did not mention providing ‘excellent care’ or ‘compassionate care’ to the patient," he says. "Well, properly explaining medication or making sure pain is controlled are how care is provided. So asking patients questions about how well you’re doing these things completely connects back to the mission and values of an organization."
Best practices for improving HCAHPS scores
The growing importance of the HCAHPS has led many hospitals to begin examining their practices and identifying ways to improve patient experience. Improving scores may be a lot simpler than many hospital leaders think, says Mr. Studer. Most often, it boils down to consistently providing better communication.
In the new book, "The HCAHPS Handbook: Hardwire Your Hospital for Pay-For-Performance Success," Mr. Studer and co-authors Brian C. Robinson and Karen Cook, RN, offer a variety of tips for improving communication and, therefore, patient experience and quality.
The following tips can benefit nurses as well as physicians and all other healthcare professionals who work directly with patients in a hospital setting. While they may seem simple, they go a long way in making patients feel cared for and about.
Upon hospital admission
During patient encounters
At discharge
Quint Studer is a recognized leader and change agent in the healthcare industry and has more than 20 years of healthcare experience. Learn more about Studer Group at www.studergroup.com.
Since 2007, CMS has required most hospitals to submit HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), a standardized survey tool to measure patient perception of the quality of care received, or face payment reductions. However, beginning in its fiscal year 2013, it will move from a pay-for-reporting system to one based on pay-for-performance. That’s when CMS implements its value-based purchasing program, which will reward and penalize hospitals for performance on certain indicators, including certain HCAHPS measures.
Under the proposed value-based purchasing rule, 30 percent of each hospital's total performance score would be based on patient experience indicators as determined by HCAHPS. In the first year, the other 70 percent of the score would be based on 17 core process measures.
However, some have suggested that this weighting creates too much of a focus on patient experience as opposed to clinical outcomes. The American Hospital Association, for example, recently asked CMS to reduce this weighting to 15 percent.
But Quint Studer, founder and CEO of Studer Group, says HCAHPS results and quality are actually two sides of the same coin.
HCAHPS link to quality
Mr. Studer says the HCAHPS survey not only provides an accurate reflection of the quality of care provided but also gives hospitals a sense of how well they are performing their mission.
While it’s true that HCAHPS measures patient perception of quality, many of the results also directly connect to actual quality. Measures on whether patients received information about which medications they are taking and whether they received discharge instructions are two prime examples, says Mr. Studer.
By making sure patients take their medications properly and that they do the right things after they leave the hospital, care providers make it more likely that patients will stay safe and heal faster, he says.
HCHAPS results are also a useful tool in helping hospitals assess whether they are performing in line with their missions.
"I've never met a mission statement — at for-profit and non-profit hospitals alike — that did not mention providing ‘excellent care’ or ‘compassionate care’ to the patient," he says. "Well, properly explaining medication or making sure pain is controlled are how care is provided. So asking patients questions about how well you’re doing these things completely connects back to the mission and values of an organization."
Best practices for improving HCAHPS scores
The growing importance of the HCAHPS has led many hospitals to begin examining their practices and identifying ways to improve patient experience. Improving scores may be a lot simpler than many hospital leaders think, says Mr. Studer. Most often, it boils down to consistently providing better communication.
In the new book, "The HCAHPS Handbook: Hardwire Your Hospital for Pay-For-Performance Success," Mr. Studer and co-authors Brian C. Robinson and Karen Cook, RN, offer a variety of tips for improving communication and, therefore, patient experience and quality.
The following tips can benefit nurses as well as physicians and all other healthcare professionals who work directly with patients in a hospital setting. While they may seem simple, they go a long way in making patients feel cared for and about.
Upon hospital admission
- Manage patient expectations. By this, Mr. Studer means demonstrating to patients that you expect them to receive the highest quality care and best service possible. "Talk about the fact you want them to receive excellent care and service, and lay out that expectation," he says.
- Provide an “excellent care” hotline. Each patient should be given the name of a person to contact, along with a direct phone number, in case he or she receives anything less than excellent care. Typically the nurse manager for the unit would fill this role, visiting each new patient and providing his or her card and encouraging the patient to reach out if he or she is unhappy with the care received, says Mr. Studer.
During patient encounters
- Implement bedside shift reports. Essentially, this tactic means that any time one nurse “hands over” a patient to another — at shift change, for instance — all necessary information is exchanged at the patient’s bedside. This includes information on patient identifiers, safety checks, medications, tests and so forth.
Not only does this make patients feel they are part of their health care plan — a basic patient right — but it also allows patients to verify that all information is accurate.
“Bedside reporting greatly decreases the likelihood of misses and mistakes,” notes Mr. Studer. “It keeps patients safe. It also improves quality of care, increases nurse accountability and teamwork, and raises the patient’s trust in the organization.”
- Practice Hourly RoundingSM and Nurse Leader Rounding. Hourly Rounding essentially means that an organization has a staff member visit every patient every one to two hours, practicing a series of eight very specific behaviors every time. According to the September 2006 American Journal of Nursing, this tactic decreases call lights by 37.8 percent, decreases falls by 50 percent, decreases hospital-acquired decubiti by 14 percent and improves patient perception of care by 12 mean points.
Nurse Leader Rounding is a tactic in which nurse leaders (or their properly trained delegates) round on every patient every day. It’s meant to ensure that quality, safe, compassionate care is delivered to every patient, every time, says Mr. Studer.
“Both types of rounding allow you to head off problems at the pass,” says Mr. Studer. “When staff members are constantly in and out of the room, looking for specific things and asking carefully targeted questions, it’s far less likely that things will go wrong—and far more likely that a patient will have a positive overall experience."
- Show respect. Knock before entering and acknowledge others in the room. This applies to nurses, physicians and any other care provider who enters a patient’s room. "Asking for permission [to enter] suggests a matter of respect for the patient," says Mr. Studer.
Also, it’s important to acknowledge everyone in the room, he adds. All staff members entering the room should first give their names, roles and what they are there to do. They should also ask the patient's name and what he or she prefers to be called and should introduce themselves to the family members and visitors in the room.
“Staff members should also ensure the patient is OK with visitors being present while personal health information is discussed,” says Mr. Studer.
- Use open-ended questions. All questions should be asked in a way that promotes open-ended responses. This makes patients feel they are being listened to, says Mr. Studer. How you word questions is also important, he says. For example, he recommends not asking patients if they have questions about directions, medications, etc., but rather asking them what questions they have.
- Paraphrase patient responses. This demonstrates to patients that providers are listening and that they fully understand what patients are saying. Mr. Studer recommends using language such as, "I want to make sure I heard you correctly" and "Let me understand…."
At discharge
- Thank patients. When the time for patients to leave the hospital is approaching, in addition to providing clear discharge instructions, staff members should say thank you.
“Actually, each staff member who comes in contact with the patient throughout the stay should thank him or her for choosing the hospital,” says Studer. "Reinforce at every opportunity that you want to make it a great experience for the patient.”
Quint Studer is a recognized leader and change agent in the healthcare industry and has more than 20 years of healthcare experience. Learn more about Studer Group at www.studergroup.com.