HCAHPS: How Pharmacists can Impact Patient Experience Meghan E. Tolan, PharmD, MBA Candidate PGY2 Health System Pharmacy Administration Resident The Johns Hopkins Hospital

Disclosure I have no relevant financial relationships or commercial interests to disclose for this presentation.

Objectives Summarize the purpose and goals of the HCAHPS survey Describe the relationship between HCAHPS performance and CMS reimbursement Identify how pharmacists can impact patient experience in the hospital setting

Pre-Assessment Which of the following survey questions can pharmacists impact through direct patient care? A.How often was your pain well controlled? B.How often did hospital staff describe possible side effects in a way you could understand? C.When I left the hospital, I clearly understood the purpose for taking each of my medications. D.A, B and C

Customer Experience

The Institute for Healthcare Improvement Triple Aim Available from: Accessed 2015 Sept 1.

HCAHPS Survey Hospital Consumer Assessment of Healthcare Providers and Systems Consists of 32 standardized questions Used to measure experience of adult inpatients with an overnight stay Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

Purpose of HCAHPS Drive to establish national standards for comparing patient perceptions of care Way to uniformly measure and publicly report patients’ perspectives on their inpatient care Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

Goals of the HCAHPS Survey 1.Produce comparable data on patients’ perspectives of care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers 2.Create incentives for hospitals to improve their quality of care 3.Enhance public accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

HCAHPS Survey Instrument

CMS Rules: Communicating with Patients about the HCAHPS Survey Hospitals can inform patients that they may receive a survey after discharge To prevent bias of survey results, hospitals CANNOT: –Post or hand out copies of the survey –Ask patients any HCAHPS questions –Encourage patients to answer questions in a particular way –Indicate that the hospital’s goal is for all patients to rate them as a “10,” “Definitely yes,” or an “Always” –Imply anyone will be rewarded for positive feedback from patients –Ask patients to explain why they did not rate a hospital with the most favorable rating possible –Offer incentives of any kind for participation in the survey Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

HCAHPS Public Reporting Reported four times each year Lag time for CMS reporting CMS adjusts results to create “level playing field” –Adjustments made for mode and patient mix Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

Reporting of HCAHPS Scores Hospital Compare – Available from: Accessed 2014 Oct 17.

Top-Box Response Survey QuestionScaleTop-Box During the hospital stay, how often was your pain well controlled? Never, Sometimes, Usually, Always Always 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? or 10 When I left the hospital, I clearly understood the purpose for taking each of my medications. Strongly Disagree, Disagree, Agree, Strongly Agree Strongly Agree Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

HCAHPS Star Ratings Image:

CMS Reimbursement Implications Inpatient Prospective Payment System (IPPS) Value Based Purchasing (VBP) in 49 states and Washington D.C. Quality Based Reimbursement (QBR) in Maryland

Value Based Purchasing CMS initiative Established by The Patient Protection and Affordable Care Act of 2010 Rewards hospitals with incentive payments for quality of care Applies to Medicare and Medicaid patients Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines Mar.

Financial Drivers (FY 2016) Available from: Accessed 2015 Sept 1.

HCAHPS and Pharmacists How does HCAHPS affect the way I take care of my patients? Pain Management Patient Education Transitions of Care

HCAHPS Survey Questions Directly Impacted by Pharmacists Identified by Johns Hopkins Hospital Department of Pharmacy Q13: During this hospital stay, how often was your pain well controlled? Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Q16: Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Q17: Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Q25: When I left the hospital I clearly understood the purpose for taking each of my medications. Additional questions are still important!

Pharmacist-Driven Initiatives at Johns Hopkins Hospital Care Coordination Services Teach Back Competency “2 Patients per Day” Initiative Learner Huddle Pharmacy Ambassador Program SMART Goal

Department of Pharmacy HCAHPS Scorecard At or above 75 th percentile compared to entire nation At least 3 percentage points improvement over last year (compared to “FY 2014 Baseline”) Below 75 th percentile nationally & < 3 percentile improvement

Looking Ahead HHCAHPS (Home Health) CGCAHPS (Outpatient) EDCAHPS (Emergency Department) Pediatric CAHPS Surgical CAHPS

Post-Assessment Which of the following survey questions can pharmacists impact through direct patient care? A.How often was your pain well controlled? B.How often did hospital staff describe possible side effects in a way you could understand? C.When I left the hospital, I clearly understood the purpose for taking each of my medications. D.A, B and C

Key Takeaways Nationally, there is an increased focus placed on patient experience quality measures If we aim to improve patient experience and the care we provide, scores will follow

Acknowledgements Kimberly Sparks, Service Excellence Jacob Smith, PharmD, MBA, Assistant Director of Quality Improvement and Regulatory Affairs Todd Nesbit, PharmD, MBA, Director of Pharmacy Patient Care Services

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