By Cyndi Tierney , Research Consultant (CG-CAHPS and Other Surveys), HealthStream
I’ll be honest. CG CAHPS was not high on my mind when I accompanied my mother in law to her oncology appointment. I wasn’t going to observe her doctor’s communication skills; I, along with my two sisters-in-law, were going as part of her support system, her ‘daughter posse.’
By the time we left, I had witnessed an extraordinary physician and patient interaction.
Poor Communication Can Have a Drastic Healthcare Effect
When Mardi was diagnosed with cancer six months ago, she was shell-shocked. Shocked by the diagnosis and equally shocked by the treatment options. It didn’t seem possible for her to have cancer—Mardi was too busy taking classes and dancing and dating and church activities. Then the pharmacy delivered Tarceva to her doorstep. No previous conversation with her medical doctor to share in deciding if this was the route to take.
A nurse herself, with a lifelong love of alternative medicine, she did not immediately jump on the chemotherapy wagon. She found a naturopathic doctor who specialized in oncology and became a vegetarian. She joined a support group and read up on every treatment option out there. She quietly fired her medical doctor. My mother in law is no lay-down.
Using Communication Skills for Patient Benefit
Several months later, Mardi was cautiously ready to meet with Western Medicine again—this time with a new oncologist and a fresh perspective. The doctor introduced herself to us by first name, made time to greet every member of the family, with small chat about where we lived, how was Christmas, etc. Most of the doctor's conversation was with Mom, but at times, she talked to all of us and made sure we were involved in the visit.
When Mardi gave her history to the doctor I was struck by how little the doctor said. She leaned forward, she gave non-verbal cues that she understood, and she let my mother-in-law just talk. Not once did she interrupt. When she did speak, it was gentle and reassuring. This physician was truly present for her patient.
The whole room shifted a little when Dr. O addressed the naturopathic treatment regimen Mardi has been following. She spoke highly of mom’s ND providers and was equally respectful about their expertise not being hers, and hers not being theirs. It was reassurance to mom that several patients have both providers as their cancer doctors. Wow, a collaborative and complementary approach to treatment.
Caring Enough to Change Minds and Hopefully Improve Outcomes
The doctor agreed with Mardi’s request for another PET scan and used the opportunity to open the door for other treatment options. Here’s what I loved—Dr. O managed to educate everyone in the room, clear misconceptions, and probably change minds without ever discounting anyone. I could almost feel her deliberate choices of words. “Yes, that is an option. It’s an excellent second line of defense,” then she would elaborate. Later, she’d come back and introduce us to a first line drug she prescribes. She never said “This is better than that,” or “I wouldn’t recommend this route.” If this seems like a minor point, maybe it is, but it didn’t feel that way in the room. A sick person deals with plenty of negative words and this doctor just wasn’t allowing a single one of them to enter her domain. Oh and she walked us out, wishing each of us well in our travels back home, like new friends you would in your own home.
Once in the car, I wanted to hear from Mardi. “How did you think it went, Mom?” I asked. “Did she do anything you wish she didn’t or was there something you wished she had done? “ A slight pause as she rethought the appointment, “No, I don’t. Do you?” And then, the true blue litmus test for relationships, “I trust her.” And all three daughters agreed, ”Me too, Mom, me too.”
The CG-CAHPS survey assesses patient experiences in physician practices and other non-acute care settings. Learn about HealthStream CG-CAHPS services here.
Patient-Centered Medical Homes (PCMH) are growing in number across the U.S. The medical home is no longer just a concept, thanks to provisions in the Affordable Care Act (ACA), which call for the government to begin supporting efforts to establish and test medical homes.
Patient Centered Medical Homes are being Developed Country-Wide
Currently, more than 40 states are developing patient-centered medical home programs through the Medicaid and Children’s Health Insurance Program (CHIP). Additionally, the Centers for Medicare & Medicaid (CMS) Innovation Center, formed through the ACA, supports the advancement of primary care services through its Comprehensive Primary Care Initiative, a public/private collaboration that provides funding for primary care activities that take place outside of the physician-patient visit. As well, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration includes 500 community health centers in 44 states that are receiving funding to reorganize as patient-centered medical homes.
PCMHs are NOT Just Government Solutions—Employers and Insurers are Involved!
But it’s not just government that is promoting the rapid growth of PCMHs. A multitude of healthcare stakeholders are either starting or supporting PCMH initiatives, including medical groups, medical societies, insurers, quality organizations, and large employers. As of June 2012, the National Committee for Quality Assurance (NCQA) recognized 4,220 PCMHs, a big leap from 3,300 practices at the end of 2011. Large insurers, such as Aetna and WellPoint Inc., as well as integrated delivery networks, including Group Health in Seattle, have launched PCMH networks.
An Emphasis on Patient-Centered Care
The patient-centered medical home is gaining ground because it provides a solution to a big industry problem: lack of patient-centered care. By coordinating all care through the primary care medical practice, the PCMH is poised to address the healthcare needs of growing numbers of patients with chronic, complex conditions and the Baby Boomers who are entering their senior years.
The PCMH model offers financial incentives for primary care physicians (PCP) to form and direct caregiver teams comprised of specialists, nurses, pharmacists, social workers, chiropractors, and other healthcare resources to provide specific services for the patient, saving time and costs, and ideally improving quality and patient outcomes.
Better in Terms of Patient and Financial Outcomes
In addition to the PCMH taking a significant step toward providing “whole” patient care, the opportunity for financial rewards is great. Already, some large pilots are demonstrating millions in savings. These favorable outcomes mean 2013 is likely to be an even bigger growth year as primary care physicians and others decide the time is now to enter the medical home business.
This white paper examines:
- The PCMH Model and its value for optimizing patient care
- How medical homes can be agents of change
- Why an emphasis on primary care can deliver positive results
- How NCQA recognition is critical to PCMH success
- How HealthStream supports practices seeking NCQA recognition and distinction
Download the White paper.
These Are HealthStream's Most-Viewed Blog Posts for 2012!
The Top 10 Hospital and Healthcare Issues to Watch in 2012
HealthStream Research Consultant Robin Rose identifies 2012's top ten issues for which healthcare providers need to prepare. Some of these are driven by changes in the patient population; others are directly linked to the Affordable Care Act and other government initiatives. It is clear that healthcare is in the process of major change, and our goal is to help healthcare organization be ready for it.
HCAHPS: What "Always" Looks Like as a Patient
HealthStream Research Consultant Bonnie Lowry examines her own hospital experience in light of her considerable knowledge of HCAHPS and all the components of patient experience that it measures. She wrote, “So how would a crabby market research consultant rate her experience at Vidant Medical Center? I actually pulled up a copy of the HCAHPS survey when I got home just to see if I could find a single instance where I would not be able to give them a top box rating. Despite their size, their teaching status, their construction and their capacity, I could not find a single question where I could not give them an unqualified top box rating.”
Why Always? Because It’s the Right Thing to do. (Think About HCAHPS.)
In a guest post, Customer Kevin Driver of Raleigh General Hospital writes about HCAHPS Survey responses and why “Always” is the only acceptable survey answer. He states “for most of us, the only acceptable response to the above questions would be Always. If we were inconvenienced by a response of Usually, we would likely change jobs, banks or airlines. And if the situation were emergent or if we are in the vulnerable position our patients sometimes face, our lives could be changed forever by the inconvenience or shortcomings of encountering less than Always.”
Full AHA Learning Suite Now Available from HealthStream
As a complement to our existing HeartCode training, HealthStream now offers the comprehensive portfolio of online courses from the American Heart Association (AHA), the universally trusted and recognized world leader in emergency cardiovascular care resources. Whether your employees are updating their professional skills or being introduced to emergency cardiovascular response training for the first time, HealthStream provides AHA courseware to help you effectively achieve your training objectives.
Beware -- CG-CAHPS is on the Way
HealthStream Research Consultant Robert J. Ogden addresses the need to get ready for mandatory CG-CAHPS Surveys. While there are fewer than 3,900 hospitals participating in the HCAHPS survey, there are more than 700,000 CG-CAHPS eligible physicians in over 200,000 physician offices. Many of these physicians are now employed by hospitals and we anticipate many more will become hospital employees in the coming years. Healthcare leaders are just now beginning to become aware of this CAHPS instrument and the impact it will have on the future of the healthcare landscape.
The Power of One, Applied to HCAHPS
HealthStream Research Consultant Gwen Faust writes of customer Freeman Hospital, in Joplin, Missourri, and how its staff has maintained attention to HCAHPS and other requirements in the face of tornado devastation. She states “So what does a hospital like Freeman do in light of natural disasters, utilization beyond capacity, and HCAHPS and Value Based Purchasing? What can we expect of a staff experiencing such professional and personal stressful overload? Freeman chose to continue striving to improve their patients’ experience of care. As their HealthStream consultant, I went onsite this fall and presented an HCAHPS Improvement Strategies session for their managers and directors. Several weeks later I spoke with several of their nursing leaders about how to work with staff that was so stressed out emotionally and physically. How far could they push? How much more could they expect of them?”
Pharmacists Making A Difference... on HCAHPS!
HealthStream Research Consultant Bo Hansen recently shared a customer success on the HCAHPS Survey in an unexpected area. When the pharmacy director at Sanford Medical Center in Bismarck, ND, saw scores that ranked in single digit percentiles, he decided to take action and implement a program to improve the hospital’s scores on this particular dimension. The pharmacist started rounding on patients who were being discharged from the hospital. The way the program works is that the discharging nurse notifies the pharmacists when the patient is ready to be discharged. One of a team of three pharmacists then goes to the floor to teach the patient about the meds he will be taking after returning home.
HealthStream Spotlight - Competency Q&A with a Clinical Expert
HealthStream’s Competency and Performance Expert Lynne Howe, RN answers a series of competency-focused questions for the benefit of readers. She writes, “These recommendations are not assumed to be exhaustive; they merely represent a productive pathway toward organizational excellence. It is always insightful to remain cognizant of the high-level vision to create a culture of safety where patient outcomes are optimized. By ensuring that all members of the healthcare team are empowered and professionally supported through your competency and quality programs, you enable employees to lead your organization in creating an open, honest, and responsive culture of patient safety end employee satisfaction.”
Checking Your HCAHPS Data? How Often... is the Question!
HealthStream Research Consultant Gwen Faust addresses organizations’ anxiety about HCAHPS and monitoring their results. She writes, “As the first HCAHPS performance period (discharges July 1, 2011 through March 31, 2012) draws to a close and Value Based Purchasing is becoming a reality, hospital leaders across America are looking at their patient experience data (HCAHPS) with a deeper interest and greater scrutiny. With this higher level of concern, clients are looking to their vendors for timely reporting of data and want the ability to view data easily and often. How often to view HCAHPS data is the subject of this blog. I asked my HealthStream colleagues for their recommendations.”
Use Performance Management in Healthcare, Support Employee Engagement
This guest blog post by HealthStream Partner Michael Cohen, a healthcare management and employee development consultant, addresses how employee engagement continues to be a hot topic in healthcare. Michael shares how performance management is a necessary part of the process for encouraging engagement. The post prominently features a checklist that can help healthcare managers ensure they have the most engaged staff possible in their facility.
[This blog post introduces the sixth installment of HealthStream's new Accountable Care Organization (ACO)-focused white paper series. As the sixth of eight sponsored papers, it describes how CG-CAHPS will eventually be the mandated patient experience survey for ACOs.]
To better assess and compare the quality of healthcare, many provider organizations have started to administer the Consumer Assessment of Healthcare Providers and System (CAHPS®) Clinical & Group Survey (CG-CAHPS), which asks patients to report on their experiences with physicians and their staff. The survey includes versions for patients receiving primary care, specialty care, and pediatric care.
Endorsed by the National Quality Forum in 2007, this standardized survey is increasingly becoming the instrument of choice for health systems, health plans, medical groups, and accountable care organizations (ACOs) to evaluate and improve the care patients receive. In some cases, use of this survey has become a requirement.
About CAHPS and CG-CAHPS
The CAHPS program is a multi-year initiative of the Agency for Healthcare Research and Quality (AHRQ) to support and promote the assessment of consumers’ experiences with healthcare. The goals of the CAHPS program are twofold:
- Develop standardized patient questionnaires that can be used to compare results across providers and overtime
- Generate tools and resources that providers can use to produce understandable and usable comparative information for both consumers and healthcare providers
AHRQ first launched the CAHPS program in October 1995 in response to concerns about the lack of good information about the quality of health plans from the enrollees’ perspective. At that time, numerous public and private organizations collected information on enrollee and patient satisfaction, but the surveys varied from sponsor to sponsor and often changed from year to year. Over time, the program has expanded beyond its original focus on health plans to address a range of healthcare services and meet the various needs of healthcare consumers, purchasers, health plans, providers, and policymakers. The program is currently in its third stage, often referred to as CAHPS III. The CAHPS program is a collaborative effort of public and private research organizations. Collectively, these organizations are known as the CAHPS Consortium.
CG-CAHPS is a Realistic Conclusion
The growing recognition of patient experience as an important element of quality has created a strong imperative for physician practices to identify and implement initiatives for achieving high levels of patientcentered care. This is reinforced by the by the following ACO definition:
“Once implemented, an ACO must demonstrate patient-centeredness. It would accomplish this, in part, by having a beneficiary experience of care survey in place, a process of evaluating the health needs of the ACO’s assigned population, systems to identify high-risk individuals, a means of internally reporting of quality and cost metrics, a mechanism for the coordination of care, and a way for patients to access their health records.” 8
In other words, you need to institute a provider organization, medical practice, PMCH, or ACO, that helps promote evidence-based medicine, patient engagement, care coordination, and patient-centered care that is efficient, accurate, and measured. CG-CAHPS is the obvious survey choice for demonstrating this achievement.
In discussing ACOs and CG-CAHPS, this white paper includes:
- History of the Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- Clinical and Group CAHPS (CG-CAHPS) Overview
- What Issues or Concerns Still Exist with CG-CAHPS?
- Let’s Begin to Think About and Plan for CG-CAHPS – Q&A with Cyndi Tierney, CG-CAHPS Expert and HealthStream Consultant
Download the Paper.
[This blog post introduces the second installment of HealthStream's new Accountable Care Organization (ACO)-focused white paper series. As the second of eight sponsored papers, it describes the final form of the ACO.]
On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), released its final rule for the Medicare Shared Savings Program, which involves the establishment of Accountable Care Organizations (ACO) and is set to take effect January 1, 2012.
The Initial ACO Ruling Generated Significant Criticism
The initial ruling on March 31, 2011 by CMS generated a tremendous amount of criticism from various healthcare providers and organizations who found it to be overly complicated, risky, and unrealistic to implement. The final ruling seems to be a little bit more user-friendly after more than 1,300 comments were submitted to CMS after the release of the proposed ACO rule. “The Medicare agency listened carefully to the concerns before finalizing the rule”, said previous CMS Administrator Donald M. Berwick, MD, “for example, the final rule will increase incentives and streamline the shared savings program, extending the benefits of the new program to a broader range of beneficiaries.”
The Second ACO Ruling Eased Some ACO Requirements
ACOs will still have to make a three-year commitment to care for a group of at least 5,000 Medicare beneficiaries under the program. However, a few important aspects of an ACO have been modified in the final rule. Here are a few important changes from the proposed rule to the final rule as well as provider and healthcare organization responses.
This paper discusses final rule changes applying to:
- Reduced required quality measures from 65-to 33
- The likelihood most ACOs will go immediately to Track 2
- Continued participation despite net losses
- Eliminated EHR requirements for reporting quality measures and general use
- Sharing beneficiary claims data
- The advance payments model
ACOs Now Have Greater Flexibility and Still Some Challenges
The final rule makes a number of revisions that add flexibility and may encourage greater participation in the Medicare Shared Savings Program (MSSP). Nevertheless, despite these modifications, providers will continue to face large start-up costs and uncertain savings in establishing and participating in ACOs.
The jury is still out whether or not ACOs will be embraced by the provider community. Many providers likely will take a wait-and-see approach as to how those providers who do initially participate work within the confines of the MSSP. Until actually put into practice, the MSSP cannot be considered to be fully vetted.
Download the White Paper.
By Don Larson, Senior Product Director, HealthStream
While release of new survey specifications by the Agency for Healthcare Research and Quality (AHRQ) isn’t typically the stuff of headlines, one component of their Clinician and Group survey (CG-CAHPS) launch may bring welcome news to healthcare providers. Until now, AHRQ’s approach (and by extension, CMS’s approach) with surveys like HCAHPS has remained fairly conservative, favoring traditional methodologies like phone and mail. With the coming of CG-CAHPS, however, the agency has finally approved the use of email and internet-based data collection, or e-survey, as an option.
Could this fundamental change signal a coming trend in CAHPS surveys? Let’s explore some of the industry drivers fueling the change, along with some key findings from HealthStream’s e-survey pilot testing.
CG-CAHPS Survey Background
The CG-CAHPS survey is designed to measure the physician office patient experience. The survey is not yet mandated by CMS. But CMS’s recent proposed rule revising the physician fee schedule included CG-CAHPS in new quality reporting measures, with plans for an initial survey pilot as early as 20131. When the survey is mandated, it could impact more than 700,000 physicians in over 200,000 practice sites nationwide, as well as numerous mid-level providers.
The sheer scale of the survey is likely one reason AHRQ first approved e-survey as an option for CG-CAHPS. A second factor may be the anticipation of pushback from physicians, many of whom are still acclimating to the need for a patient experience survey. So the promise of scalability that e-survey brings is important from the standpoint of both cost and practicality.
For now, the fact that CG-CAHPS is not nationally mandated means that hospitals and physician practices are able to test these new cost-effective options and gain the competitive advantage that early adoption brings.
For e-Survey, The Time is Right
E-survey has historically been passed over as a legitimate data collection platform for good reason. Internet and email adoption rates have lagged behind for some of the key patient populations, namely seniors age 65 and over. But with U.S. overall internet adoption rates now over 80 percent, and over half of seniors now online and using email, the platform is ready for initial use2. Given that email still lacks the ubiquity that phone and mail enjoy, however, it is unlikely that CMS will approve e-survey options that lack follow-up by a more proven methodology. That is why HealthStream has focused our testing on these “mixed mode” methodologies and recommends this approach for our CG-CAHPS clients.
Key Takeaways from e-Survey Testing
HealthStream’s initial testing of the e-survey’s effectiveness as a data collection platform has been highly successful. In one of our initial pilot studies, combining three waves of e-survey followed by a single wave of mail follow-up, we saw an impressive response rate of over 28 percent for the e-survey component alone.
The chart presented here shows the percent of total responses by age segment, with the red bars highlighting e-survey results and the gray bars indicating mail responses. As you might expect, the 64 and under demographics drive the majority of e-survey responses. However, the lower number of e-survey responses from seniors shown here is not adjusted for the relative lack of email addresses collected for that age group in this particular pilot sample.
This leads to the first key takeaway from our initial testing: The e-survey option gives physician practices and hospitals additional leverage in the quality of their survey products. Organizations that collect higher percentages of valid patient email addresses will yield a proportionally higher rate of survey returns – and a lower cost per completed survey.
The second takeaway is that mixed-mode methodologies provide a highly complementary approach to fielding surveys, as demonstrated by the traditional bell curve of the combined e-survey and mail response totals in the chart. This ensures that your organization is reaching a representative sample of your patient population while leveraging more scalable and cost-effective options for deployment.
The final observation is that hospitals and physician practices should start preparing for e-surveys now. Regardless of when you might start your CG-CAHPS deployment, it will take some time to implement the processes and systems needed to collect patient email addresses. Providers should also begin using effective patient communication tools, such as the posters and collateral materials HealthStream provides their clients, to educate your patient base about why it is important for them to provide email addresses.
Will e-Survey Catch On?
It is likely that AHRQ and CMS are using CG-CAHPS as a test bed for the efficacy of e-surveys. If it shows success, as it has in HealthStream’s experience, the platform will likely begin gain approval for use with other patient survey types (except where certain patient characteristics require the use of phone surveys, as is the case with In-Center Hemodialysis survey3). For surveys that are not currently mandated, such as ED and related outpatient surveys, the platform provides a great opportunity to return a higher number of total survey completes at much more affordable price points
The rise of consumerism and the concurrent adoption or patient engagement channels like social media, patient portals and personal health records, will continue to increase the need for patient email addresses – as well as the likelihood that patient will be willing to share their addresses. Additionally, ACOs and patient-centered care will ultimately hinge on the ability of these organizations to manage patient populations across a number of critical segments, requiring meaningful and effective communications with healthy populations as well as sick and chronically-ill patients.
Email and internet communication is already becoming a vital link in this next generation of care delivery. So too will monitoring the patient experience along and beyond the continuum of care, bringing with it a new generation of more sophisticated and integrated survey solutions.
1 Federal Register, July 30 https://www.federalregister.gov/articles/2012/07/30/2012-16814/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-dme-face-to-face
2 Pew Internet, April 2012 http://pewinternet.org/
3 For more info see http://blog.healthstream.com/blog/?Tag=In-Center+Hemodialysis
Click here to Download the free HealthStream CG-CAHPS white paper.
Just when providers were getting accustomed to the HCAHPS survey, which measures patients’ perception of hospital care, another CAHPS survey is just around the corner. The CG-CAHPS survey is aimed at physician groups and hospitals that employ physicians. It seeks to measure the physician office experience and by all counts is even more daunting than HCAHPS. When it becomes fully mandated, CG-CAHPS could impact some 700,000 physicians. The goals of CG-CAHPS, like the other CAHPS surveys, are to boost the patient experience of care and improve the service quality of care. In other words—big challenges are looming.
CG-CAHPS Adoption is Moving Forward
While CG-CAHPS is still voluntary and the standards haven’t yet been released, telltale signs indicate both that it will be rolled out with great magnitude and that it will follow a similar path of HCAHPS and HH-CAHPS (home health). Originally approved in 2007 by the National Quality Forum (NQF), CG-CAHPS is already being integrated into a number of new care delivery models, including patient-centered medical homes and accountable care organizations. Additionally, a number of state and regional initiatives have incorporated the survey, including the Massachusetts Health Quality Partners and the Minnesota Community Measurement initiatives— both sponsored by a broad-based coalition of payers, providers, and purchasers.
CG-CAHPS Survey Endorsement
A more telling sign that HHS may be ready for CG-CAHPS adoption is the Measure Applications Partnership’s (MAP) endorsement of the survey. MAP, a public-private partnership convened by the NQF, was created as part of the Affordable Care Act to provide input to HHS on the selection of performance measures for public reporting and payment programs. In their initial report on the “Coordination Strategy for Clinician Performance Measurement,” released in late 2011, MAP notes that the current performance indicators are “dominated by process measures” and states that “the addition of Clinician-Group CAHPS…would greatly enhance the measure set.”
What You Need to Know About CG-CAHPS
HealthStream’s new CG-CAHPS-focused white paper, CG-CAHPS Has Become the New Hot Survey, details how this survey is rapidly gaining traction as an industry standard. It includes such details as:
There are still multiple challenges associated with CG-CAHPS.
- Industry adoption of CG-CAHPS is already occurring.
- CG-CAHPS use is recommended for accountable care organization (ACO) accreditation and patient-centered medical home (PCMH) distinction
- There are numerous clinical and business reasons to implement CG-CAHPS before it is mandatory.
- Data from CG-CAHPS has the potential to shift physician and hospital market share and transform other healthcare industry dynamics.
Click here to Download the free white paper.
A guest blog post by Kevin Driver; Director, Organizational Excellence; Raleigh General Hospital
Recently, CMS published updated HCAHPS top box scores to its Hospital Compare Web site. Later this year, they will use these scores to adjust Medicare reimbursement based on performance. As you know, most HCAHPS survey questions use a frequency scale of Always, Usually, Sometimes and Never. We strive for Always for a number of reasons, including the fact that, as the top box score, it is the only answer we get credit for on Hospital Compare and under value-based purchasing (VBP). Any other response essentially counts as a zero.
Some advocate that Always may be unrealistic or too hard to achieve. Others are understandably disappointed that we don’t earn at least partial credit for the other three responses. But, if we turn the tables and look at our expectations as customers, it is easier to see why Always matters and, more importantly, why “Usually” just isn’t good enough.
Putting yourself in the place of the customer, think about how you would answer the following questions and, more specifically, would any answer other than Always be acceptable to you?
- How often did your employer give you your paycheck on-time?
Always Usually Sometimes Never
- How often did your health insurance work when you attempted to use it?
Always Usually Sometimes Never
- During your last visit to the bank, how often did the bank accurately record the amount of your deposit/withdrawal?
Always Usually Sometimes Never
- During your last trip, how often did the pilot / airline maintenance crew complete pre-flight inspections between flights?
Always Usually Sometimes Never
- During your last trip, how often did the flight team get you to your destination/connection in a timely manner?
Always Usually Sometimes Never
- During your last trip, how often did your luggage arrive with you at your final destination?
Always Usually Sometimes Never
- When called, how often did your Fire Department respond in a timely manner to your needs?
Always Usually Sometimes Never
- When called, how often did the Police respond in a timely manner to your needs?
Always Usually Sometimes Never
For most of us, the only acceptable response to the above questions would be Always. If we were inconvenienced by a response of Usually, we would likely change jobs, banks or airlines. And if the situation were emergent or if we are in the vulnerable position our patients sometimes face, our lives could be changed forever by the inconvenience or shortcomings of encountering less than Always.
Always is more attainable than we think. I encourage you to work with your local team to identify ways you can work together to create “Always events.” What steps can you take as an individual to offer a more consistent patient experience? What steps can you take as a team to ensure you are doing the right thing at each and every patient encounter?
Reprinted by permission from LifePoint hospitals. Learn more about LifePoint Hospitals.
Learn more about HealthStream’s Patient Experience (HCAHPS) Survey.
Learn more about improving your HCAHPS scores.
By Robert J. Ogden, Senior Consultant (HCAHPS & Other Surveys), HealthStream
In early 2006, hospital leaders were beginning to deal with the new world of the Hospital- Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey – the CMS survey measuring the hospital experience of the inpatient. The implications for hospitals were not well understood at that time, but since the introduction of Value Based Purchasing, the impact of HCAHPS has become clear.
Shortly after the introduction of the HCAHPS survey, CMS released the first version of the CAHPS Clinician & Group Survey (CG-CAHPS) to allow patients to rate their experiences of their doctors’ visits. Late last year CMS introduced updated versions of the CG-CAHPS survey and changed “this doctor” to “this provider” to allow for the inclusion of advanced practice clinicians. In many ways, we are now at a similar point with CG-CAHPS that we were with HCAHPS in 2005, but on a much larger scale. Consider this: While there are fewer than 3,900 hospitals participating in the HCAHPS survey, there are more than 700,000 CG-CAHPS eligible physicians in over 200,000 physician offices. Many of these physicians are now employed by hospitals and we anticipate many more will become hospital employees in the coming years. Healthcare leaders are just now beginning to become aware of this CAHPS instrument and the impact it will have on the future of the healthcare landscape.
Initiatives Are Driving CG-CAHPS Adoption
Several initiatives are driving adoption of the CG-CAHPS survey for physician offices and clinics. A state initiative such as the one in Minnesota is one example. Federal initiatives include a requirement to measure the patient experience of care for those implementing a recognized Patient-Centered Medical Home (PCMH) or an Accountable Care Organization (ACO). Another federal initiative, the Physician Compare website, is expected to include provider-specific results on the patient experience of care. Healthcare organizations that employ physicians are also driving adoption of CG-CAHPS as they look for ways to link patient experience scores to physician compensation.
While CMS has not yet mandated the use of the CG-CAHPS survey, it is important that healthcare leaders have a basic understanding of the survey, the available versions, and the specific instrument used for the various initiatives. For example, the Minnesota project uses the “last visit” version, while those implementing a medical home model will use an expanded version of the 12 month instrument that incorporates the CAHPS PCMH Item Set. If your organization is considering one of these initiatives, it is important to understand the differences.
Lots of Unanswered Questions About CG-CAHPS
Just like in 2005 prior to launching the HCAHPS survey, there are still a lot of unanswered questions about CG-CAHPS. Here are some questions one of my clients recently asked me.
- Which physicians will be included? Will any physician specialties be excluded?
- Will CMS adopt the “12 month” version or the “last visit” version?
- How will patients be selected for the survey?
- Will CMS adjust the data that are reported on the Physician Compare website as they do with the HCAHPS results posted on the Hospital Compare website. If so, what adjustments will be made?
- Will there be a value based purchasing program for physicians that incorporates the patient experience and quality measures reported to the Physician Quality Reporting System (PQRS)?
- How long will it be until CMS implements a physician value based purchasing program?
Although the questions are many and the answers are few, it is important that healthcare leaders are aware of the coming changes as they will be significant. We may not have all the answers about CG-CAHPS at this time, but ignoring the coming storm is not a good idea. Is your organization doing anything to prepare for CG-CAHPS? Will your organization be ready?
Learn More about HealthStream's CG-CAHPS Solution.
2012 Is A Critical Year for Healthcare!
The number of large-scale issues and concerns facing hospitals is staggering. It seems that the challenges facing healthcare organizations have rarely been as great as this moment when government initiatives, regulations, and demographic changes require healthcare providers to change how they provide care and do business.
As counselors and advisors to hospitals and organizations across the country, HealthStream's research consultants pay lots of attention to approaching issues as well as to the concerns they hear from healthcare executives. When problems threaten, we work to help customers find solutions and handle them in the best way possible.
One recent task we set for ourselves at HealthStream was to identify the top ten issues for which healthcare providers need to prepare. Some of these are driven by changes in the patient population; others are directly linked to the Affordable Care Act and other government initiatives. It is clear that healthcare is in the process of major change, and our goal is to help healthcare organization be ready for it.
Here are the top ten issues that we have identified:
Aging Baby Boomers Will Change the Healthcare Market
Government Initiatives are Leading to Financial Uncertainty for Hospitals
It’s the Right Place and Right Time for Simulation
Patient-Centered Medical Homes Solve Some Big Problems for the Healthcare Industry
2012 is a Make or Break Year for Meaningful Use
The Race is on for ICD-10 Implementation
Everyone’s Watching the ACO Early Adopters
Hospitals See Business Value of Social Media
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