Detroit Medical Center GRAND ROUNDS UROLOGY HCAHPS: Transparency and Patient Participation In Healthcare KEVIN G. SIMOWSKI, J.D. CORPORATE VICE PRESIDENT CUSTOMER SERVICE June 30, 2010

HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems

HCAHPS FACTS Developed by CMS and AHRQ Participation required for hospitals to receive a full IPPS payment update beginning 2007 All General Acute Care Hospitals Eligible Patients are 18 years old and over who have had an overnight stay 300 surveys minimum over a rolling 12 month period (25 per month)

HCAHPS Questions Six Composite Areas: Communication with Nurses Responsiveness of Hospital Staff Communication with Doctors Pain Control Communication about Medicines Discharge Information Two Individual Questions: Room Cleanliness Quiet at Night Two “Global” Questions: Overall Rating of Hospital (0 to 10) Likelihood of Recommending the Hospital

DMC HCAHPS Results The number of hospitals reporting their HCAHPS results has increased by 1,255 (50%) since the first public reporting in March First line indicates Top Box* response for all U.S. hospitals from July 1, 2008 – June 30, (3,775 hospitals and 2.4 million completed surveys) Second line indicates Top Box* response for all Michigan hospitals for stated time period. (131 hospitals) *Top Box - percentage of patients that provided the most positive answers to the survey question

These results are from patients who had overnight hospital stays from July 1, 2008 – June 30, 2009 Patients reported how often their doctors communicated well with them during their hospital stay. “COMMUNICATED WELL” means doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect Bars below tell the percent of patients who reported that their doctors “ALWAYS” communicated well.

Composite 2 Communication with Doctors During this hospital stay, how often did doctors: – Treat you with courtesy and respect? – Listen carefully to you? – Explain things in a way you could understand? Never Sometimes Usually Always

COMPOSITE 2 Communication with Doctors 0 (-4)

Composite 4 Pain Management During this hospital stay, how often: – Was your pain well controlled? – Did the hospital staff do everything they could to help you with your pain? Never Sometimes Usually Always

COMPOSITE 4 Pain Management (-2) (-1) (-2)

Composite 5 Communication About Medicines Before giving you any new medicine, how often did hospital staff: – Tell you what the medicine was for? – Describe possible side effects in a way you could understand? Never Sometimes Usually Always

COMPOSITE 5 Communication about Medicines +2 (-2) (-1) (-1) +1 (-1) (-3)

Composite 6 Discharge Information During this hospital stay: – Did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? – Did you get information in writing about what symptoms or health problems to look out for after you left the hospital? YES NO

COMPOSITE 6 Discharge Information 0 0 (-1)

Overall rating of this hospital (0-10) 0 (-2) (-1) (-3)

Willingness to Recommend this Hospital 0 (-1) (-1) (-1)

Transparency Hospital Compare Website page views (“hits”): – 157,500 two weeks prior to March 28, 2008 debut – 2.5 million in April 2008 – 3.6 million in May 2008 – 11.5 million in June 2008 Other Measures on Hospital Compare: – Surgical Care Improvement/Surgical Infections Prevention – Heart Attack/Heart Failure Process of Care Measures – Pneumonia Process of Care Measures – MORTALITY

IMPROVEMENT IDEAS Introduce yourself to patient and family members Have a seat! Smile if appropriate. Explain your role on the health care team Provide pen and paper “Questions for our physician” Let patients/family know when you are available Provide realistic expectations

MORE STEPS Ask, before you leave, if there is anything else they would like to discuss Demonstrate empathy: “I understand this is a stressful time, is there anything I can do to help?” Involve the patient in the decisions that are made Actively LISTEN (avg time is 20 seconds) Provide answers in understandable, nontechnical language Ask colleagues in high performing areas

LANGUAGE PROBLEMBETTER BENIGNHarmless (Not Cancer) DYSFUNCTIONProblem INTAKEWhat You Eat or Drink COLLABORATEWork Together DECUBITIS ULCERBedsore EDEMASwelling

PATIENT COMMENTS (The “Good”) “Physicians were very professional and courteous” “The doctor was very good and nice on explaining everything to me and I appreciate it very much” “Although my father was hard of hearing, physicians worked hard to make sure he understood what was going on” “My doctor made me feel that she really cared…I looked forward to her arrival each day” “LOVE my physicians”

PATIENT COMMENTS – Not so much “The physician would not talk to you. You would wait all day to see one and they would be in your room 5 minutes.” “He seemed to not have a very good bedside manner and was not there when I was out of surgery to answer questions” “Doctor didn’t keep promise to come back, very poor in keeping word.” “Staff physicians flew in and out and explained very little.”

SYSTEM QUALITY DASHBOARD Press Ganey – Standard Physician Questions

Health Care Reform Legislation and the Impact on HCAHPS Patient Protection and Affordable Care Act Title III-Improving the Quality and Efficiency of Heath Care Section Hospital Value-Based Purchasing Program Program to begin Fiscal Year 2013 (October 1, 2012) HCAHPS measures among quality measures to be selected (along with AMI, Heart Failure, Pneumonia, infections) Sec. 3001(a)(5)(B)(i) “Appropriate Distribution.” “(H)ospitals achieving the highest performance scores receiving the largest value-based incentive payments.” – (ii) “(U)sing the higher of its achievement or improvement score for each measure”

Health Care Reform Legislation HCAHPS-NEXT STEPS 1% of payments tied to VBP in FY 2013, 1.25% in FY 2014, 1.5% in FY 2015, 1.75% in FY 2016 and 2% in FY 2017 and beyond Inpatient Rehabilitation to begin quality reporting program in – VBP pilot to start by 2016

HCAHPS (Media) Coverage 1.14 million page views/month on Hospital Compare in 2009 Posted on Quality Check (Joint Commission) beginning in 2009 Consumer Reports August, 3, 2009 US News & World Report October 20, 2009 USA Today January 25, 2010 NEJM October 30, 2008 “(We) would like to reiterate that the full, complete and official HCAHPS results are those publicly reported on Hospital Compare.” –CMS HCAHPS Executive Insight, March 2010.

RESOURCES Hospital Compare HCAHPS Info AHRQ HQA JOINT COMMISSION PRESS GANEY

CONCLUSION July 1, 2008 – June 30, 2009 data available to the public on CMS website as of March 18, surveys per site per year (25/month) CMS rule ties HCAHPS participation to Medicare reimbursement in FY 2008 and performance in FY 2013 Additional information: (“Executive Insight”)