the quest for “always” nursing excellence conference april 19,2013
TRANSCRIPT
The Quest for “Always”
Nursing Excellence ConferenceApril 19,2013
Objectives Discuss the History of HCAHPS
Understand the Eight (8) Patient Experience of Care Dimensions
Review Current South Carolina Performance
Relate HCAHPS to the Value Based Purchasing initiative
HCAHPS
Hospital Consumer Assessment of Healthcare Providers and Systems
Other surveys: CAHPS® HHCAHPS CG-CAHPS
Overview of HCAHPS Developed by the Agency for Healthcare Research and Quality
(AHRQ) for the Centers for Medicare and Medicaid Services (CMS)
National, standardized patient perception study related to hospital care experience
Designed to: Measure compliance with evidence based practices Provide consumers with information regarding patient perspectives
on quality of care (not patient satisfaction) Allow comparisons to be made between healthcare facilities Create a metric that can be used for performance incentives (Pay-
for-Performance) Increase overall accountability
2002 200620102005 2008
CMS partners with AHRQ to develop HCAHPS survey
October 2006, CMS implements HCAHPS survey
HCAHPS survey endorsed by National Quality Forum
Value Based Purchasing
Incentive Payments
Inpatient Perspective Payment System (IPPS)
Patient Protection and Affordable Care
HCAHPS Timeline
2012
First public reporting on HCAHPS
Reimbursement Dollars are at
Risk $$$
HCAHPS Survey Process Survey design
20 experience of care questions 2 Overall Global ratings 7 Demographic questions 3 Care transition questions
Random Sampling of eligible discharges 300 completed over a 12 month period (minimum) No interviewing or distributing surveys while patients
are still in hospital Four (4) Survey modes
Mail Telephone Mail with telephone follow-up Active Interactive Voice Response (IVR)
HCAHPS Survey Process
Inclusions for survey Adult patients (18 years and older) Medical, Surgical or Maternity care Overnight stay or longer Alive at discharge
Exclusions from survey Pediatric patients Psychiatric patients Hospice discharges Prisoners or law enforcement patients Patients discharged to nursing homes and skilled
nursing facilities No Publicity patients
HCAHPS Experience of Care Dimensions
Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff Pain Management Communication about Medications Hospital Environment Discharge Information Overall Hospital Ratings
HCAHPS Dimensions
HCAHPS Questions
Communication with Nurses * Nurse Courteous and Respectful Nurse Listens Carefully Nurse Explains Things
Communication with Doctors Doctor Courteous and Respectful Doctor Listens Carefully Doctor Explains Things
Responsiveness of Hospital Staff * Assistance to Bathroom Response to Call Button
Pain Management * Pain Well Controlled Help With Pain
Communication About Medicines * Explain New Medications Explain New Medication Side Effects
Hospital Environment Cleanliness of room Cleanliness of bathroom
Discharge Information * Discharge Help Discharge Symptoms
Overall Hospital Ratings Overall Hospital Ratings Willingness to Recommend
* Designates Patient Care Dimensions related to the Magnet Sources of Evidence
AlwaysUsually
Sometimes
Never
HCAHPS Primary Rating Scale
“Always” is the only score that counts!!
HCAHPS Overall Ratings
Overall Rating of the Hospital Using any number from 0 to 10, where 0 is the worst
hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay? (Percent 9 & 10 Ratings)
Willingness to Recommend Would you recommend this hospital to your friends and
family? Definitely no Probably no Probably yes √ Definitely yes
So How Are We Doing????
HCAHPS PerformanceSouth Carolina Results
"Percent Always"April 2011 - March 2012
66
68
68
72
73
80
84
0 10 20 30 40 50 60 70 80 90
Staff explanations about medications?
Did patients receive help quickly fromhospital staff?
Was the area around patients roomskept quiet at night?
Were patients' pain well controlled?
Were the patients' rooms andbathrooms kept clean?
Nurses Communicate well with patients
Doctors communicate well with patients
Percent "Always" Response
Communication with Nurses 1. During this hospital stay, how often did nurses treat you with courtesy and respect?
1Never
2Sometimes
3Usually
4√Always
2. During this hospital stay, how often did nurses listen carefully to you?
1Never
2Sometimes
3Usually
4√Always
3. During this hospital stay, how often did nurses explain things in a way you could understand?
1Never
2Sometimes
3Usually
4√Always
HCAHPS PerformanceSouth Carolina Compared to National Average
April 2011 - March 2012
63
66
60
70
73
78
81
66
68
68
72
73
80
84
0 10 20 30 40 50 60 70 80 90
Staff explanations about medications?
Did patients receive help quickly fromhospital staff?
Was the area around patients roomskept quiet at night?
Were patients' pain well controlled?
Were the patients' rooms andbathrooms kept clean?
Nurses Communicate well with patients
Doctors communicate well with patients
Percent "Always" Response
National Average South Carolina
Communication about Medications15. During this hospital stay, were you given any medicine that you had not taken before?
1Yes
2No If No, Go to Question 18
16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
1Never
2Sometimes
3Usually
4√Always
17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
1Never
2Sometimes
3Usually
4√Always
Screening Question….
23. During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.
1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree
24. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree
25. When I left the hospital, I clearly understood the purpose for taking each of my medications.
1 Strongly disagree 2 Disagree 3 Agree 4√ Strongly agree 5 I was not given any medication when I left the hospital
UNDERSTANDING YOUR CARE WHEN YOU LEFT THE HOSPITAL --- New Questions
Overall Ratings
HCAHPS PerformanceSouth Carolina Results
April 2011 - March 2012
70
69
71
71
0 10 20 30 40 50 60 70 80
Willingness torecommend
Overall Rating
National Average South Carolina
Percent of Patients Giving 9 or 10 Ratings
Definitely Would Recommend
The Key is Improvement…..
The database is moving……
Without continual improvement we will fall behind!!
South Carolina = 69% 9 & 10 ratingsSource: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013
HCAHPS SummaryOverall Rating Performance
April 2010 - March 2011
1 1 1
3
2
7
4
2
6 6
4
3
2
5
3
0 00
1
2
3
4
5
6
7
8
60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76
Percent 9 & 10 Ratings
Nu
mb
er o
f S
tate
s
34% of States have a 70% or higher 9 & 10 ratings
South Carolina = 71% 9 & 10 ratingsSource: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013
HCAHPS SummaryOverall Rating Performance
April 2011- March 2012
0
1
0
2
0
4 4 4
5
7
4
5
3
2
7
2
00
1
2
3
4
5
6
7
8
60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76
Percent 9 & 10 Ratings
Nu
mb
er o
f S
tate
s
46% of States have a 70% or higher 9 & 10 ratings
So Why is HCAHPS so Important??
Value Based Purchasing
Value Based Purchasing Value Based Purchasing (VBP) is a CMS program that
rewards organizations based upon the quality of care they provide – not the volume of services they provide
Established in 2010 with the passing of the Affordable Care Act
Value Based Purchasing is designed to improve clinical outcomes and the patient experience of care during hospitalizations
Pay-for-Performance Performance Periods Reimbursement dollars at risk
Value Based Purchasing –Performance Periods
Fiscal Year 2013 = 1.0% at risk Performance Period ( 7/1/2011 – 3/31/2012)
Fiscal Year 2014 = 1.25% at risk Performance Period (4/1/2012- 12/31/2012)
Fiscal Year 2015 = 1.5% at risk Performance Period (1/1/13- 12/31/2013)
Fiscal Year 2016 = 1.75% at risk
Fiscal Year 2017 = 2.0% at risk
HCAHPS and Value Based Purchasing FY 2013 --1.0% at risk
HCAHPS (30%) Clinical Care Processes (70%)
FY 2014-- 1.25% at risk HCAHPS (30%) Clinical Care Processes (45%) Outcomes (25%)
FY 2015-- 1.5% at risk HCAHPS (30%) Clinical Care Processes (20%) Outcomes (30%) Efficiency (20%)
Scoring Achievement points Improvement points
Value Based Purchasing – Patient Experience of Care Domain Summary (Report Example)
Database
Dimension Score is basedon the greater of
Improvement or achievementpoints
Value Based Purchasing– Key Points
We must understand that reimbursement dollars are at risk Budget neutral program
Our current performance impacts future reimbursement
All organizations are working to improve their performance
So What Can You Do?
Understand your own organizational HCAHPS scores http://www.medicare.gov/hospitalcompare/
Identify areas of strengths and opportunities Prioritize areas of opportunity Utilize evidence based tools (i.e. AIDET, Rounding,
etc)
Communicate results at all levels of the organization – “Connect the Dots” for all staff
Celebrate and share your successes
Final Thoughts Pay-for-Performance is here to stay
Expect more transparency as it relates to Value Based Purchasing performance
Improvement is not optional
HCAHPS and Value Based Purchasing are organizational objectives
The Quest for “Always” starts with each one of us
The Quest for “Always”
Questions
Sources/Links
http://www.theberylinstitute.org/?page=IMPX_VIDEO
http://www.hcahpsonline.org/
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/HospVBPNPC100412.pdf