1. HCAHPS And Value Based Purchasing 101

2. Truths of Current Healthcare Climate
HCAHPS/VBP are not going away.
Healthcare is a business-All organizations must generate a profit.
Reimbursement is based on outcomes not effort.
Patients are our mission and the mission ALWAYS comes first.
The Golden Rule applies to all situations.
Nursing staff now has the unique opportunity to become a revenue generator instead of a cost center.

3. What is CAHPS? Consumer Assessment of Healthcare Providers and Systems
Produces comparable data for public reporting
Creates incentive for organizations to improve
Enhances public accountability and transparency
Hospital CAHPS
Home Health Care CAHPS
Clinician and Group CAHPS
… more to come!
CAHPS provides an apples to apples metric for public
reporting—additional measurement may be needed for ongoing
quality improvement activities and monitoring.
HCAHPS was developed between AHRQ (Agency for Health Care Research and Quality & CMS (Center for Medicare/Medicaid) as a way to have a standardized survey tool to be used for public reporting & to create an environment of competition that would lead to improvement. The goal of HCAHPS is to push towards consumer driven healthcare. It’s the age of consumerism and transparency in Health Care.

4. 4 Objectives of HCAHPS
Standardization permits meaningful comparisons across hospitals for public reporting
Increased hospital accountability and incentives for quality improvement
Pay-for-performance (Hospital VBP)
Enhanced public accountability

5. Why is CAHPS ® Important?
Consumers have access to the data
Consumers relate more easily to CAHPS ® data than to clinical data
Some use CAHPS ® data to choose hospitals
CAHPS ® is in the public eye
Media coverage
Promotion by hospitals themselves
Participation linked to reimbursement
Will have volume, revenue, and reputation implications down the road
CMS placed ads in local newspapers encouraging the use of hospitalcompare.org
Consumers have access to the data results via the hospitalcompare.com website.
As patients and caregivers have become more familiar with the data results and the meaning behind them, organizations are posting HCAHPS scores on their websites, and the popularity of showcasing their excellent standings will increase through media publications as consumers become more educated.

6. HCAHPS Survey
Sample of the hcahps survey

7. HCAHPS Content: Seven Composites
1.Communication with nurses
- Nursing related questions comprise about 50% of Survey
2.Communication with doctors
3. Responsiveness of hospital staff
4. Pain management
5.Communication about medicines
6. Discharge information
7. Care Transition

8. Other Questions You Impact
Hospital Environment
During this hospital stay, how often were your room & bathroom kept clean?
Never, sometimes, usually, always
During this hospital stay, how often was the area around your room quiet at night?
Global Rating
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?
0-worst—10-best possible hospital
Would you recommend this hospital to your friends & family?
Definitely no, probably no, probably yes, definitely yes

9. General Survey Guidelines
Patient Eligibility
Adult (18+)
Medical, surgical or maternity care
Overnight stay, or longer
Alive at discharge
Excludes hospice discharge, prisoner, foreign address, “no-publicity” patients, patients excluded due to state regulations, and patients discharged to nursing homes, SNF swing bed within hospital, and skilled nursing facilities
HCAHPS encompasses ~80-85% of inpatients
I just wanted to cover a brief reminder about who gets the survey because CMS recently announced a change to this list in April.
The addition was it is not sent to patients who are discharged to SNF or nursing homes.

10. Communication Guidelines
Hospitals SHOULD
Encourage response to the survey
“It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge.”
Improve the patient experience
Distribute the communication guidelines
Hospitals SHOULD NOT
Ask patients for a certain score
Indicate that their goal is to receive a certain score
New: Show the HCAHPS survey or cover letter to the patient prior to survey administration
New: Mail pre-notification letter or postcards
Making a connection to surveys for patients before they see the survey in their mailbox is very important. One of the big things we encourage our clients to do is to share the survey with employees & have them take the survey in a staff meeting. Once you have their survey responses you can compare them to your patient responses. Typically your internal responses will be lower than your patient responses, you tend to be harder on yourself because you know how the processes are supposed to work & where there might be shortfalls. You can also try to identify the biggest disparities between the two datasets.
By treating the survey like an open book test with your staff they are more likely to talk about the survey with patients. You can also have the survey in admission or discharge packets to educate the patient on the survey.
Just be sure that no one is scripting for “always” or a specific score.

11. Value Based Purchasing
Now that you have a clear understanding of the history & public reporting let’s look toward the future of HCAHPS.

12. Value-Based Purchasing
Common Terminology: Pay for performance or Pay for quality
Health Reform Updates
Value Based Purchasing started in fiscal 2013
Current hospital VBP program will transition from “Pay-for-Reporting” to “Pay-for Performance”
Up to 2% of your Medicare reimbursement will be at stake
Hospitals will lose reimbursement unless their performance is at benchmark levels
Includes HCAHPS performance and Core Measures
Will start at 1% and this will be ramped up to 2% by 2017
Who will be reimbursed for HCAHPS performance?
Top performing healthcare providers
Greatest improving healthcare providers
CMS is transitioning from a system that pays based on the quantity of services to one that pays for the quality of the care provided. One way to achieve this goal is with a value based purchasing program. Whatever the name, the goal is to be an active purchaser of high quality healthcare services.
The Patient Protection and Affordable Care Act of 2010 authorizes CMS VBP in several settings. It also sets out some basic guidelines and timelines
CMS will use two different criteria to evaluate each organization. You will receive a score for both attainment and improvement and keep the higher of the two.
Attainment points reward you for your performance compared to your peers. CMS will review your national percentile ranking to determine the amount of points you will be awarded. The higher your national percentile ranking the higher your reimbursement will be.
Improvement points reward you for improving your own performance year over year. You will be awarded points based on how much your national percentile ranking has increased between the base year and the year of performance being reviewed.
Some of you may remember that CMS had previously considered including a minimum performance measure. That measure would have awarded you points based on your lowest scoring area. The reform law forbid CMS from including that criteria in the VBP calculation for hospitals. Because they thought people would purposely do poorly to show a dramatic increase the following period.

13. Hospital Value Based Purchasing - Measures
Future Measures
AHRQ patient safety indicators, inpatient quality indicators and composite measures
Nursing sensitive care
AMI, heart failure and pneumonia mortality rates
First, we will review the Hospital VBP plan in detail. This plan is the most comprehensive implementation outlined in the Patient Protection and Affordable Care Act. It will also give us insight into what we can expect as CMS expands VBP to additional setting.
The legislation provides broad guidance around which measures to be included for hospital VBP. Both clinical and HCAHPS (patient satisfaction) data will be used to calculate reimbursement. For the clinical calculation CMS will use core measure data related to acute myocardial infarction (AMI), Heart Failure (HF), Pneumonia (PN), and Surgeries from the Surgical Care Improvement Project (SCIP).
The exact measures within each of these categories will be at the discretion of the Secretary of HHS. To be eligible for selection the measure must be reported on the Hospital Compare website for 1 year prior to inclusion in VBP. We can use the data currently available on Hospital Compare as a guide to the initial measure that will be included. The Secretary has the authority moving forward to expand the measure set. Based on the legislation this will likely include a measure of Healthcare Associated Infections. We can also anticipate that the Average Medicare Spending per Beneficiary will be added by 2014.
While not specifically mandated, based on previous materials released by CMS we believe that the clinical data will account for 60-70% of the calculation and HCAHPS will represent 30-40%.
The legislation provides broad guidance around which measures to be included for hospital VBP. Both clinical and HCAHPS data will be used to calculate reimbursement. For the clinical calculation CMS will use core measure data related to acute myocardial infarction , Heart Failure, Pneumonia, and Surgeries from the Surgical Care Improvement Project.

14. Thank you for attending!
ww.cms.gov