1. Nursing Excellence Conference April 19,2013
The Quest for “Always”
Nursing Excellence Conference
April 19,2013

2. 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

3. HCAHPS
Hospital Consumer Assessment of Healthcare Providers and Systems
Other surveys:
CAHPS®
HHCAHPS
CG-CAHPS

4. 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

5. HCAHPS Timeline
Value Based Purchasing Incentive Payments
Inpatient Perspective Payment System (IPPS)
HCAHPS survey endorsed by National Quality Forum
Reimbursement Dollars are at Risk $$$
2005
2010
2008
2012
2002
2006
CMS partners with AHRQ to develop HCAHPS survey
First public reporting on HCAHPS
Patient Protection and Affordable Care
October 2006, CMS implements HCAHPS survey

6. HCAHPS Survey Process Survey design Four (4) Survey modes
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)

7. HCAHPS Survey Process Inclusions for survey Exclusions from 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

8. 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

10. HCAHPS Primary Rating Scale
Always
Usually
Sometimes
Never
“Always” is the only score that counts!!

11. 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

12. So How Are We Doing????

14. Communication with Nurses
1. During this hospital stay, how often did nurses treat you with courtesy and respect?
1 Never
2 Sometimes
3 Usually
4√ Always
2. During this hospital stay, how often did nurses listen carefully to you?
3. During this hospital stay, how often did nurses explain things in a way you could understand?

16. Communication about Medications
15. During this hospital stay, were you given any medicine that you had not taken before?
1 Yes
2 No  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?
1 Never
2 Sometimes
3 Usually
4√ Always
17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
Screening Question….

17. UNDERSTANDING YOUR CARE WHEN YOU LEFT THE HOSPITAL --- New Questions
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.
25. When I left the hospital, I clearly understood the purpose for taking each of my medications.
5 I was not given any medication when I left the hospital

18. Overall Ratings

19. The Key is Improvement…..
The database is moving……
Without continual improvement we will fall behind!!

20. 34% of States have a 70% or higher 9 & 10 ratings
Source: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013
South Carolina = 69% 9 & 10 ratings

21. 46% of States have a 70% or higher 9 & 10 ratings
Source: Summary of HCAHPS Survey Results. HCAHPSonline.org/, CMS 3/29/2013
South Carolina = 71% 9 & 10 ratings

22. So Why is HCAHPS so Important??
Value Based Purchasing

23. 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

24. 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/ /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 24

25. HCAHPS and Value Based Purchasing
FY % at risk
HCAHPS (30%)
Clinical Care Processes (70%)
FY % at risk
Clinical Care Processes (45%)
Outcomes (25%)
FY % at risk
Clinical Care Processes (20%)
Outcomes (30%)
Efficiency (20%)
Scoring
Achievement points
Improvement points

26. Value Based Purchasing – Patient Experience of Care Domain Summary (Report Example)
Database
Dimension Score is based
on the greater of
Improvement or achievement
points

27. 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 27

28. So What Can You Do?
Understand your own organizational HCAHPS scores
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

29. 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

30. The Quest for “Always”

31. Questions

32. Sources/Links http://www.theberylinstitute.org/?page=IMPX_VIDEO