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Assess Nurse Competencies in New Hires at Senior Living Communities


By Stella Hatcliffe, RN, MSc, CPHQ, Manager of Professional Education, Mather LifeWays Institute on Aging

Stella Hatcliffe, Mather Lifeways Institute on AgingAs our population ages, our nursing focus will increasingly shift to care of older adults. This presents an exciting opportunity to positively impact services within senior living communities. I have been excited to observe a national effort to make long-term care less institutional and more home-like. There has been increased emphasis to support a person-centered approach in senior living, and to embrace services provided in ways that the resident desires. Senior living communities are becoming more focused on providing education to promote staff competencies and empower them to provide services based on the desires of the resident, not what is most efficient for the community.

To that end, it is important that to consider these cultural shifts, in addition to assessing competencies and validating credentials, during the hiring process. We need to explore whether potential employees embrace the core values our communities require to promote person-centered care. During the interview process it is important to ask potential new employees to share examples of how they can provide respectful culturally-sensitive service and promote resident preferences. 

Learn more about HealthStream's workforce development solutions for post-acute care staff.

Useful Questions for Assessing Cultural Sensitivity and Person-Centered Orientation 

I have found it insightful to explore these scenarios during new hire interviews by using these questions: 

  • Within our community we seek to show respect and embrace our resident preferences. Can you share some examples of how you have provided respectful communication and service to a resident?
  • Can you tell me about a time you had the experience of providing service to a resident/ family  with cultural/religious beliefs that were new to you?
  • Could you share an experience in which you had to handle a distressed resident, how did you handle it and what were the outcomes? 

HealthStream Workforce Development Solutions for Post-Acute CareMany of our older adults in senior living communities have chronic conditions such as dementia, diabetes, and cardiovascular health issues. There is an increasing need to support nurses’ critical thinking competencies to avoid unnecessary hospital readmissions. We can accomplish this through understanding elements of complex clinical assessments and necessary reporting required assuring high levels of service and early interventions.

Assessing Nurses’ Critical Thinking Skills for Senior Living Communities

Enhanced critical thinking and adoption of evidence-based practices has also been shown to reduce falls and pressure ulcers. Within senior living communities, we are also increasingly focused on promoting staff understanding of palliative and end-of-life care through collaboration with hospice services. Thus, assessing the new nursing staff’s abilities in effective communication with physicians and critical thinking skills are also essential competencies.

An interview question I have used to explore this is:

  • If you had to contact a physician and communicate a concern, for example if a resident suddenly got acutely confused and disoriented, how you would approach this? 

Assessing Work Style and “Fit”

Through reviewing potential employee responses to these questions I have gained good insights into their work styles and “fit” for my community. With the shift in long-term care communities from using the term “geriatric care” to “care of older adults” and “aging in place,” we are acknowledging that these places where people live—often for long periods of time. As we continue on this person-centered journey, we must remain focused on validating and assessing potential candidates prior to making a hiring decision and continue to enhance employee competencies and understanding of person-centered services.

To learn more about HealthStream’s Turnover Solution, which will help you make hiring decisions with confidence, click here.

Analyzing Physician Engagement - Physician Ratings of Admin Skills


Randy Carden, Ed.D, Senior Counsultant, HealthStreamIn this article by Dr. Randy Carden, Senior Research Consultant, from the most recent issue of HealthStream's PX Advisorwe seek to answer two questions that have recently been posed to HealthStream by a client who participates in our physician satisfaction and engagement survey, Physician Insights. This is a standard survey that hospitals typically administer to their medical staff each year to obtain physician feedback and to monitor progress on improvement activities. A key component of this survey is to ask medical staff members to rate administration on a variety of factors—one of which is “administrative skill.” The questions our client posed are these:

Q1: Do ratings of administrative skill vary by physician demographics?
Q2: What are the key drivers of administrative skill?

The Analysis

HealthStream PX Advisor January 2014To explore research question #1, several comparisons were completed. Specifically, ratings of administrative skill were compared across gender, specialty, years of practice at the hospital, and age of physician. The first comparison related to gender of the physician and differences in ratings of administrative skill. Male physicians rated administrative skill significantly higher than female physicians.

A second comparison was performed to explore whether ratings of administrative skill varied across specialty category (hospital-based, medical specialist, primary care, psychiatry, surgical specialist, or other). It was found that physicians with different specialties varied significantly in ratings of administrative skill.

Follow-up analyses indicated that primary care physicians rated administrative skill significantly higher than hospital-based physicians or surgical specialists. No other signif icant differences were found between specialties.

A third analysis was conducted to determine whether ratings by physicians with differing numbers of years served at the hospital (less than 2, 2 - 5, 6 - 10, or 10+) varied on administrative skill ratings. It was found that the number of years at the hospital was significantly related to administrative skill. Physicians who spent less than 2 years at the hospital rated administrative skill significantly higher than any other group. Those who had spent 6 - 10 years at the hospital rated skill significantly lower than the other groups. No other differences were found between groups.

A fourth analysis was conducted to determine whether age group (less than 35, 35 - 44, 45 - 54, 55 - 64, and 65 or older) differed on ratings of administrative skill. Age group was found to be significantly related to administrative skill, or older age group had significantly higher ratings than any other age group. This was followed by the 55 - 64 age group, with ratings significantly higher than the remaining age groups. There were no significant differences among the younger age groups.

Discussion and Conclusion

Our research indicates that there ARE demographic differences in how medical staff members rate administrative skill. Specifically…

  • Male physicians rated administrative skill significantly higher than female physicians
  • Primary care physicians rated administrative skill significantly higher than hospital-based, medical, and surgical physicians
  • Physicians that spent less than 2 years at the hospital rated administrative skill significantly higher than any other group
  • Physicians in older age groups had significantly higher ratings than any other age group

These findings show that hospital administrators might improve their perceived skill level among medical staff members by focusing most closely on female members of their medical staff, specialists and hospital-based physicians, and physicians who have tenure of more than two years at the facility.

The research further suggests that perceptions of skill are based largely on communication and personal interaction between administrators and medical staff members. Hospital administrators are not so much judged by their physicians for the efficiency of the emergency department, the scheduling of the operating rooms, or the overall quality of the patient care provided as they are by their personal, meaningful communication with physicians and their responsiveness and follow-through when issues arise.

Complete the form below to Access the full article and download this issue of PX Advisor.

Learn more about HealthStream's Research and Consulting Services.

Healthcare's Evolving Role of Service Excellence


This blog is an excerpt of an article by William L. Bodnar, President of The Leader’s Board, LLC, in the January issue of PX Advisor, HealthStream's quarterly magazine focused on improving patient experience.

HealthStream PX AdvisorToday’s push for superior customer service is being underscored by the financial incentives/disincentives imbedded in Medicare payments methodology. Strategists also point to the long term reality of population health management and its ability to reduce future costs by those covered under an ACO or similar risk-bearing model. It simply makes sense that systems invested in keeping their members healthy will want to keep them loyal and part of the system’s covered lives.   

Forward-thinking care organizations are adapting customer relationship management programs from other industries, streamlining customer service recovery efforts, deepening training efforts, and increasing the use of customer service goals in their pay and bonus programs. Others are using their data analytics and multiple survey tools to discover which customer service efforts produce value in the eyes of patients or their families. Architects are designing customer-centric facilities. Caregivers are pushing for systems that combine the fields of patient safety, risk management, customer service, and process management to achieve the best outcomes for everyone involved. 


In the most forward-leaning organizations, new definitions of the “vision” or strategies that are designed around customer service are appearing. For example, Virginia Mason Medical Center (Seattle, WA) has developed a five-year strategy which has three goals: 

  1. Integration of quality and service
  2. Partnership with patients and families
  3. Engaging, developing, and activating their people.

There are extensive plans and benchmarks behind each of these areas. According to Virginia Mason’s Susan Haufe, “The activities and goals that we have in place are more far-reaching than simply tracking HCAHPS scores.”

At Cone Health (Greensboro, NC), the effort to define great customer service goes beyond a simple definition or set of benchmark data. The system produces a series of short films showcasing patients, families, and caregivers using inspiring patient stories. These patient stories are typically filmed in their homes and connect staff to the obstacles of everyday life and how Cone Health’s caregivers support patients’ recovery efforts. Films are viewed at a department level so that staff can discuss its message with their peers and manager. According to Chad Brough, Executive Director in Cone Health’s Office of Patient Experience, the films have changed the context of the patient experience throughout the entire health system. “These real life stories told from the patient’s perspective help everyone see the difference we make at Cone, and the stories hit home. They make our commitment to exceptional care far more than a slogan or statistical goal.” 

At Phoenix-based Banner Health, staff members are looking beyond inpatients to deliver a coordinated, consistent, and exceptional experience across their entire delivery system. Pat McNulty-Collins from Banner’s North Colorado Medical Center (Greeley, CO) says the organization is looking to move towards a complete customer-centric culture as part of its core strategy. “The patient’s experience begins with the very first contact; it is imperative that all staff are engaged in delivering exceptional care and service to our patients. Our patient-focused approach has transcended to the ambulatory environment.” Banner has more than 300 clinics and employs more than 1,000 physicians and advanced practice providers. 

Summa Health (Akron, OH) has implemented a variety of efforts to pull together its service recovery program and CRM efforts. Carmen Natale, Summa’s System Director of Patient Experience, believes that it is no longer enough to implement strategies that only address service, but they must also address value and outcomes. Strategies ranging from pre-visit education about not only procedures, but what to expect during their hospital stay, to post-visit follow-up improve experience and reduce readmissions. This is the value “sweet spot” all CRM activities must target. More about Natale’s thoughts can be found in the August 2013 edition of Healthcare Financial Management

Download the entire article to learn how other healthcare organizations are supporting and emphasizing service excellence through:

  • Data Analytics
  • Patient and Family Focus
  • Evidence-based Design
  • Institutional Excellence Initiatives
  • The quality/safety/service intersection
  • Process Improvement Efforts


Complete the form below to download this issue of PX Advisor.

Healthcare Exclusion and Sanction Screening Best Practices from PreCheck


PreCheckAs an introduction to PreCheck, a recent HealthStream talent management partner, we would like to share the following best practices from Frank Pierce, National Healthcare Data Bank (NHDB) Compliance Director. As Product Manager for SanctionCheck, a streamlined sanction checking service, Frank works with healthcare compliance officers every day to protect their facilities from excluded individuals and entities. With over ten years’ experience in this area, Frank has come across all types of scenarios while helping clients identify physicians, employees, vendors, and other staff who have been excluded from participating in federal health programs.

What are the regulatory requirements regarding checking for exclusions or sanctions? 

The answer is not as straightforward as you might think. In May 2013, the U.S. Department of Health and Human PreCheck for HealthcareServices (DHHS) Office of Inspector General (OIG) issued a Special Advisory Bulletin on The Effect of Exclusion from Participation in Federal Health Care Programs ( ). In the Special Advisory Bulletin, the OIG states that healthcare organizations cannot make payments to excluded providers. Since at least 1999, healthcare organizations have had access to the OIG’s List of Excluded Individuals and Entities (LEIE), allowing them to run sanction checks for determining whether anyone on their payroll is excluded from federal health programs. While there is no specific statute or regulation that requires healthcare organizations to check the LEIE, the OIG provides the exclusion list as a risk management tool. If your facility fails to identify an excluded individual or entity, you could be subject to Civil Monetary Penalties (CMPs). While not a requirement by federal or state law, performing sanction checks is an industry best practice and could save your healthcare organization from incurring costly fines. 

What exclusion lists are recommended as part of an exclusion and sanction screening program? 

As an industry best practice, I would recommend checking the OIG LEIE as well as the General Services Administration’s (GSA) System for Award Management (SAM) database, formerly the Excluded Parties List System (EPLS). Most healthcare experts concur that both lists should be checked, but it’s also highly recommended that organizations check State Medicaid Exclusion Lists. Not all states report exclusions to the OIG. Therefore, even if you are checking the OIG LEIE as part of your exclusion screening program, there are names on the State Medicaid Lists that are not part of the LEIE. At PreCheck, we’ve identified individuals thanks to these state-level exclusion lists. We’ve seen some healthcare facilities check their local state Medicaid exclusion list, but they fail to check more than 30 other available lists that could contain an excluded individual on their staff. 

How frequently should healthcare organizations check for exclusions and sanctions? 

Ultimately, this is something that depends on your comfort zone for risk management. If your healthcare organization does not have the proper safeguards in place, you may find yourself having to explain to your management or even an auditor why an excluded individual was on your payroll for three or four months before you caught it. These are some of the risks that your facility should consider when determining the appropriate frequency of an exclusion screening policy. There are healthcare organizations that check everything—the OIG LEIE, the GSA SAM, and all public State Medicaid Exclusion Lists each month to ensure they are checking the most up-to-date available information. Civil monetary penalties can be costly and can add up quickly; therefore, it makes sense to invest the resources to minimize risk as well as to protect your patients from adverse events. It’s up to your facility to decide how frequently to conduct sanction checks, but consider that the OIG updates the LEIE on a monthly basis. Therefore, screening healthcare staff and contractors on a monthly basis provides the highest level of protection against risk. Since the OIG recommended monthly sanction checks as a best practice in its 2013 Special Advisory Bulletin, we’ve definitely seen an uptake in the number of organizations running monthly searches.

Learn more about PreCheck.

ICD-10 Delayed Until October 2015-Education Partner Precyse Responds


Precyse advises clients to use this time to focus on CDI, training, and process improvement.Precyse ICD-10 Education

Our partner Precyse has developed specific tracks to meet every ICD-10 education need for hospitals, physician offices, and post-acute care organizations. From coders and physicians to case managers, nurses, and administrative and billing staff, Precyse and HealthStream will prepare your staff and organization for productive and successful use of ICD-10 coding.

When you partner with HealthStream, the Precyse University ICD-10 solution can be provided through your existing HLC system, your current non-HealthStream learning management system or your own custom training Website. No matter your current systems or setup, Precyse and HealthStream can deliver a cost-effective, tailored ICD-10 education to all of your employees to meet their needs.

Below, please find an excerpt from Precyse's recent press release in response to the ICD-10 Delay.

Yesterday, Congress passed the Sustainable Growth Rate (SGR) Bill that extends the proposed physician rate reduction for one year, but which also includes language that delays the compliance deadline for converting to the ICD-10 system of diagnostic and procedural coding from October 1, 2014, to not before October 1, 2015. President Obama is expected to sign the bill today.

“Like everyone in the industry, Precyse has been closely watching the developments related to the SGR Bill and its effect on the transition to ICD-10. We are disappointed with the vote as our clients have spent considerable time and resources ensuring preparedness for October 1, 2014” said Chris Powell, president of Precyse. “However, this change to the legislation cannot deter us from our goals to improve the overall level of clinical documentation that will in turn improve the quality of the data that will drive the delivery of the best health care in the world.”

Learn more about Precyse ICD-10 Education from HealthStream.

Consistent with our advice the last time we experienced a delay in ICD-10 implementation, we believe there is still no time to procrastinate. Providers should use this delay to continue staff education efforts, improve their clinical documentation processes and build a strong foundation for process improvement and downstream strategic initiatives embarked upon under the Affordable Care Act.

Precyse ICD-10 EducationICD-10 will provide clinical and financial benefits to help us drive better clarity about the care that is being delivered. It is critical to stay vigilant and continue to focus on training and developing coders, CDI specialists and others who will use the data and convert it into meaningful information. ICD-10 is a measure of quality. Hospitals and physicians aspire to offer world-class care. Precyse will do our part by accurately capturing, organizing and tagging the clinical data that leads to that outcome.

Precyse has not stopped preparing for the implementation of the new coding rules and stands ready to support and meet the needs of our nearly 5,000 clients, many of whom already rely on our management, staffing and technology solutions, through our training and implementation process. Because Precyse not only supports, but also operates entire HIM and coding departments for some of our clients, we recommend three key areas of focus throughout the next 18 months.


Providers should increase clinical documentation training programs for physicians and other caregivers. This includes developing processes, guidance and support for improved clinical documentation under ICD-9 to be better prepared for ICD-10. Improved documentation skills – even minor changes such as more specificity in notes – create obvious financial and non-financial rewards: fewer claims denials, reduced audit exposure, improved case mix index and improved cash flows. Most importantly, patient care is improved when downstream clinicians can review and rely upon more complete chart notes, and better data is available for analytics and comparative studies. It is essential to target high-volume specialties within each organization most impacted by ICD-10 and train these specialists in proper documentation while training the coding team on the new coding system, then move to the next specialty for training. 

Build a Strong Foundation for Process Improvement

Providers should assess the flow of information across its organization and develop a plan to address gaps through process improvement and technology. Invest in automated systems that streamline the entire clinical documentation process. ICD-10 will not be just about retraining medical coders – it is about having better data about patients and their treatments, affording vast opportunities for improvement in data capture and processing. This leads to a more complete and useful set of codes, which is crucial in a fully automated electronic medical record environment. Today, inefficient, laborintensive workflows abound, whether involving clinical information inputs such as dictation and transcription; approvals, coding, physician queries and other myriad facets involved in billing for services; or abstracting and analyzing quality indicators to improve patient care. We also recognize the promise of new innovations such as automated speech recognition, Computer Assisted Coding using Natural Language Processing (NLP) and clinical decision support tools – but know that realizing their full promise tomorrow requires that we improve how current users interact with and use their systems today. As a member of the healthcare information management/information technology community, we must use our skills to innovate for clinicians. We must develop workflow platforms and applications that allow healthcare providers to do their jobs more efficiently and effectively. We do not want to add more time and complexity to an already challenging process.

Training and Development

Continue to invest in the training of coders, auditors and those who will use the data. Improve the basic skills of your coders and auditors in ICD-9 areas that will also be required in ICD-10. The transition to ICD-10 has pushed healthcare to appropriately invest in training our coders as skilled knowledge workers. As part of our own ICD-10 preparations, Precyse assessed the coding skills of the hundreds of coders and auditors on our staff to evaluate their ICD-10 readiness. Precyse invested in and developed a comprehensive and multifaceted online training program, while developing individual training plans for every coder. This investment has paid off for Precyse clients handsomely, yielding a better case mix index for hospitals, improving coding compliance audit results, increasing coder retention and attracting new coder recruits who are eager to develop and perfect their skills. We recommend that you perform side-by-side dual coding in ICD-9 and ICD-10, assessing the documentation and coding gaps, and target training based on these findings.

Learn more about Precyse ICD-10 Education from HealthStream.

Transform Healthcare Performance Reviews: Video and Webinar


San Joaquin Community HospitalHealthStream Customer Spotlight Video: San Joaquin Community Hospital

In a recently released customer spotlight video, HR Executive Mr. Robert Lonto, San Joaquin Community Hospital (SJCH), shares his success in transforming the performance review process at his organization. SJCH has partnered with HealthStream for many years to manage performance, competency, and learning for the employees at their facility in Bakersfield, California. 


 Sneak peek at the San Joaquin story.

Prior to using HealthStream, they had adopted a manual paper process that proved to be cumbersome and difficult to manage. Mr. Lonto shares some of the benefits he has experienced in moving to the HealthStream platform, which include:

  • Tracking and measuring compliance
  • Monitoring competency management
  • Reporting for regulatory audits
  • Accessing data for more informed decision making

Mr. Lonto will also be joining HealthStream for an upcoming Webinar presentation, Ditch the Paperwork: Transforming the Performance Review Process, where he will be discussing the benefits of utilizing the HealthStream Performance Center for employee performance management. The Webinar will be held March 26, 2014 – 1-2pm CST and is free to all attendees. 

Learn more about the webinar and register.

Learn about the HealthStream Performance Center.

Is Healthcare Ready for the eSurvey for Patients?


In this article excerpt from the just-published Winter 2014 issue of PX Advisor, Berke Bilbay, Associate Vice President, Research Reporting & Platforms and Karen Sorensen, Associate Vice President, Government Initiatives discuss healthcare's increasing embrace of Internet-based patient experience surveys.

What is the eSurvey for Patients?HealthStream PX Advisor

The eSurvey is an online survey that patients complete via the Internet. Patients receive an invitation to participate in the survey via email. They are then able to click on a link to launch the survey. Participation can be tracked in order to follow-up with non-respondents.

Best Buy does it. Home Depot does it. Even Macy’s does it.

We are talking about the instant online feedback consumers are routinely asked to provide after an experience with a business. While the rest of the world has embraced the eSurvey methodology, healthcare has been slower to implement this cost-effective and timely way to receive patient experience feedback.

But healthcare is starting to change. While acceptance has been slower in the healthcare community, HealthStream is seeing increased use of the eSurvey, especially for medical offices, emergency departments, urgent care centers, and outpatient treatment areas. As healthcare becomes increasingly wired through the electronic health record, patient portals, and online scheduling, the eSurvey has become a practical way to obtain patient feedback.

Learn more about HealthStream's Survey Research and Consulting.

How the eSurvey Methodology Works

In just three weeks, HealthStream is able to survey your entire universe of patients that have valid email addresses. Unlike traditional mail or phone methodologies where census surveying is cost prohibitive, HealthStream’s eSurvey allows you to survey all of your patients. After receipt of the patient file, HealthStream applies any de-duplication rules to ensure patients are not surveyed too frequently. We then send three waves of emails, with each wave spaced seven days apart. Completed surveys are posted overnight to Insights Online, our interactive online reporting system, and final results are available in about three weeks. No other survey methodology provides results as quickly as the eSurvey.

Response Rates that May Surprise You

While the number of Internet users is growing, perhaps the biggest concern with the eSurvey is a perception that older patients simply will not complete an online survey. While it is true that older patients are less likely than their younger cohorts to have email addresses, our experience has shown that the response rate among seniors who do have email addresses is extremely high. HealthStream’s data show that 38% of seniors with an email address complete online surveys using our threewave approach. In fact, response rates are highest among patients 65 to 74 years of age (42%), and second-highest among those 75 to 84 years of age (39%).

eSurvey Response Rates by Respondent Age

Further, HealthStream’s most current results show an overall response rate of 30% for eSurveys among patients, which compares to the national average of 33% for HCAHPS surveys (phone and mail methodologies combined).

Mobile Integration

Smartphone technology has the opportunity to further accelerate adoption of the eSurvey. In June 2013, Nielsen reported the use of smartphones had increased from 50% in 2012 to 61% in 2013. The growing number of smartphone users creates a new avenue for patients to complete an online survey. In fact, 24% of the online surveys fielded by HealthStream are completed via a mobile device. The increasing use of smartphones tablets is opening new doors for the eSurvey.

This article also addresses:

  • Which Survey Types are Right for the eSurvey?
  • Advantages of HealthStream's eSurvey
  • Best Practices in Email Address Collection
  • Developing Communication Tools
  • Develop Incentives and Benefits to Support Patient Email Address Sharing

Complete the form below for a complete download of PX Advisor.


Subscribe to HealthStream\u0026#39\u003Bs PX Advisor


HealthStream Acquires HCCS, Creating Comprehensive Compliance Solution


Nashville, Tenn. (March 4, 2014) – HealthStream, Inc. a leading provider of workforce development and research / patient experience solutions for the healthcare industry, today announced that it has acquired Health Care Compliance Strategies, Inc. (HCCS), a Jericho, New York-based company focused on interactive and engaging online compliance training for healthcare organizations. HealthStream adds to its workforce development solutions with a comprehensive curriculum of premium courseware and an outstanding application for managing conflicts of interest disclosures, along with a team of professionals with extensive industry experience and thought leadership in healthcare compliance.  

Healthcare is one of the most highly regulated industries in the U.S. and the number of regulations continues to grow, which results in growing demands for compliance training. HealthStream has long been the leading provider of workforce development solutions in healthcare, which has included its OSHA & accreditation compliance training in U.S. hospitals with its 3.7 million subscribers to its platform. With its added capabilities, courseware, and expertise from the acquisition of HCCS, HealthStream now has a comprehensive compliance solution—with a full continuum of services and training programs that addresses the broad range of compliance priorities.  

“HealthStream is a perfect fit for HCCS to further support development of the healthcare workforce,” said Ben Diamond, president, HCCS. “We are both focused on providing exceptional compliance solutions that, in turn, help to improve patient outcomes and promote compliance with ethical, legal, and accreditation guidelines. HealthStream has pioneered compliance solutions in healthcare and we are excited to play a role in building their robust compliance offering.”  HCCS

Through the acquisition of HCCS, HealthStream adds a comprehensive curriculum of premium compliance courseware and training programs, which include several bundled offerings—like the Quality Improvement Suite, Workplace Compliance Suite, General Compliance Suite, and the Research Compliance Suite. HCCS’ courses use fast, rich content, with full motion video and interactivity. Examples of the diverse compliance topics in HCCS’ courseware include HIPAA Compliance, Bioterrorism & Disaster Preparation, Patient Rights, Reducing Medication Errors, and Health Plan Compliance. Helping organizations comply with the training requirements of Corporate Integrity Agreements (CIAs) is another specialty area of HCCS that adds to HealthStream’s overall compliance solution strategy. 

HealthStream’s workforce development solutions are also expanded with HCCS’ SaaSbased application for tracking potential conflicts of interest disclosures, known as the COISMART system. Cumbersome manual processes are automated with COI-SMART as the system tracks and manages potential conflicts of interest among hospitals’ physicians, executives, and other healthcare professionals. Correspondingly, courses are also offered in “Conflicts of Interest and Research Misconduct.” COI-SMART will be offered on a subscription basis to healthcare organizations, adding another powerful, healthcare-specific application, which will be integrated with HealthStream’s workforce development platform. HealthStream’s comprehensive compliance solution will be offered primarily to corporate compliance officers in hospitals, who represent an increasingly important role in healthcare organizations. At this time, 98 percent of healthcare organizations have a corporate compliance officer (CCO) with a staff, on average, of three full-time employees. The Health Care Compliance Association now has over 9,000 active members. Alongside the growing number of federal and state regulatory requirements, the industry-wide focus on improving patient safety has further contributed to the importance of compliance programs in healthcare organizations. The addition of HCCS brings a sales team dedicated to this channel, which will be immediately expanded to cover HealthStream’s 10 sales regions. 

“I would like to extend a warm welcome to HCCS’ clients and employees,” said Robert A. Frist, Jr., chief executive officer, HealthStream. “Providing OSHA & accreditation compliance solutions to healthcare organizations has been a core offering for HealthStream for over a decade and we are excited to expand the scope of our solutions in this important area. HCCS’ premium content and thought leadership add important dimensions to our compliance solution strategy.” 

Read the full press release announcing the acquisition.

Nominations for the 2014 HealthStream Awards of Excellence Now Open!


The Awards of Excellence spotlight innovative programs and superior leadership that support organizational excellence, workforce development, patient satisfaction, employee engagement, and more. It’s an honor to recognize our customers’ dedication to methods and processes that lead to quality improvements and, in turn, improved patient outcomes.

HealthStream Awards of Excellence

The HealthStream Awards of Excellence are as follows:

Excellence through Innovation℠ Awards

These awards recognize our customers who executed initiatives that have led to improved outcomes, including, but not limited to, process improvements or quality improvements.

The Patricia E. Lane Award

Excellence through Individual Innovation

HealthStream created the Patricia E. Lane Award in 2009, in honor of Patricia E. Lane. Patricia was a HealthStream System Administrator, leader of the Virginia HealthStream User Group (HUG) since its inception, and a 29-year employee of Rockingham Memorial Hospital in Harrisonburg, Virginia, who lost her life in a tragic car accident in December 2009. She touched the lives of her co-workers and many healthcare organizations from across the state of Virginia who benefited from her expertise, sage advice, and leadership.

Excellence through Insight Awards®

These awards recognize hospitals that excel in their ability to gain insight about their patients, employees, physicians, and community through research and use that information to build excellence within their organization.

Please Note: Award submissions are not accepted for Excellence through Insight Awards, as award winners are selected based solely on data collected via HealthStream's Research Solutions.

To nominate your organization for an award or learn more, visit:

CG-CAHPS: Is the Physician Compare Website Ready for Prime Time?

By Karen Sorensen, Associate Vice President of National Initiatives, HealthStream

HealthStream CG-CAHPS SurveysOn February 24, 2014, HealthStream participated in the Centers for Medicare and Medicaid Services (CMS) Town Hall meeting about the Physician Compare website. Over 200 individuals representing various physician groups, medical associations, vendors, individual providers, as well as interested consumers attended the meeting either over the phone or in person at CMS headquarters located just outside of Baltimore, Maryland.

The goal of the meeting was to allow the healthcare community and consumers to provide comment about CMS’s plans for the Physician Compare website. With the two-fold purpose of encouraging consumers to make informed choices and to incentivize physicians to maximize their performance, the Physician Compare website was launched in 2010. Since that time, CMS has stated its intention to phase in public reporting of quality measures, including CG-CAHPS, over the next several years. And just last week, CMS added the first quality measures to the website – a subset of the Diabetes Mellitus and Coronary Artery Disease measures. These measures were posted for groups that participated in PQRS via the GPRO web interface in 2012. Overall, 141 Accountable Care Organizations (ACOs) and 66 practices with 100+ PQRS eligible providers using the GPRO web interface (e.g., GPROs) met the requirements for public reporting of their 2012 quality data.

How Measures Data is Displayed on Physician Compare

Once a group has quality measure data, a “Clinical Quality of Care” tab will be added to the practice’s profile page. The scores for each measure will be graphically displayed as stars, with the actual percentage listed to the right. Each of the five stars represents 20 percentage points. For example, if a group scored 80% on a measure four stars would be fully filled in. If the group scored 84% on a measure, four stars would be fully filled in and just a bit of the fifth star would also be filled. CMS says it made the decision to use the stars rating system because stars are “consumer-friendly and familiar to consumers.” In response to stakeholder feedback, the website also includes the actual percentage score. 

HealthStream CG-CAHPS SurveysSeveral of those attending the Physician Compare Town Hall Meeting were not in favor of the five-star rating system, citing concern that the stars do not allow consumers to appreciate statistical variations in the scores for complex quality data. 

What About CG-CAHPS?

While we have yet to see the reporting of the Patient Experience of Care Measures, or CG-CAHPS, CMS maintains that the first survey data will be reported later in 2014 “if technically feasible”  for the Medicare ACOs and GPROs. As a reminder, CMS is administering and funding CG-CAHPS data collection for these groups. Starting later in 2014, practices with 25 or more eligible providers will be able to select the CG-CAHPS survey as one of their PQRS quality measures. These practices will need to contract with a CAHPS survey vendor, such as HealthStream, to conduct the survey and submit data to CMS on their behalf. For all other providers, CG-CAHPS remains voluntary from a CMS perspective.

So, what do you think? Does the Physician Compare website allow consumers to make informed choices when selecting healthcare providers? Does it motivate providers to improve the quality of care they offer patients? Is the administrative data about providers accurate?  Is the star ratings system an over- simplification of complicated data?  Are you in favor of quality measures being reported at the individual provider level?  Should the preview period be reduced from 30 days to two weeks, as CMS has proposed?

Share Your Opinion 

Let your voice be heard. CMS is accepting written statements until 5:00 p.m. E.S.T. on Monday, March 3rd.

Via Email:

Via Mail:

Division of Electronic and Clinician Quality (DECQ)
Mailstop S3-02-01
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore Maryland 21244-1850
Attention: Rashaan Byers or Regina Chell 

Read more about the Physician Compare Initiative at

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