CG-CAHPS and e-Surveys: Will Patient Surveys Finally “Find” the Internet?
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
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