We’ve officially entered the era of reimbursement rewards and penalties for patient satisfaction, as measured by HCAHPS. Over at The Hospitalist, Dr. Win Whitcomb provides the clearest, simplest breakdown of the new reimbursement rules and formulas for performance and readmissions that I’ve seen.
We continuously work with hospitals to define the metrics that matter–the measures that will provide the best indicators of care, efficiency and overall performance. We analyzed the Medicare HCHAPS data to establish a simple measure of elite performance in patient experience. The results were interesting.
CMS reports data on about 4,700 hospitals. About 1,200 of those have insufficient or unavailable survey data.
We took the remaining 3,510 hospitals and filtered them such that the following two statements were true:
- At least 90 percent of patients rate the hospital as a 9 or 10 out of 10
- At least 90 percent of patients would “definitely” recommend the hospital
Out of 3,510 hospitals, only 37 met those criteria. Barely more than 1%. So when we talk about hospitals that report 90+ percent patient satisfaction, we are truly talking about elite performers.
So what are these elite performers doing well? Several factors contribute to the HCAHPS measures:
- Nurses responded quickly and communicated well
- Doctors responded quickly and communicated well
- Pain effectively managed
- Patients well informed about medications
- Rooms and bathrooms were clean
- Area quiet at night
- Well informed about post-discharge self care
There are reasonable folks who would argue this represents a limited perspective of patient experience. But these are the measures that determine HCAHPS scores–scores that can diminish reimbursements if they fall short. Clearly many of the measures are clinical and environmental. But all depend on hospitals coordinating care efficiently to keep patients informed and free nurses and doctors to spend time caring for patients. They can’t respond quickly and communicate well with patients if they’re chasing phone calls and phantoms. And attentive, responsive care requires nursing capacity to match patient clinical demand. Such load balancing demands a much more sophisticated approach than just assigning shifts based on the number of beds. Finally, teams must work together to ensure that environmental services coordinate with other caregivers prevent delays and make sure rooms stay ready and clean. Doing so requires central visibility and understanding of the needs of patients and the readiness of resources at admissions.
Logistics for care coordination and throughput addresses all of these requirements. And when hospitals completely embrace a logistical approach, based on throughput milestones and repeatable and reliable processes for care, they establish the framework that will sustain the responsive and efficient care that sustains elite performance in patient satisfaction.
POSTED BY Doug Walker