Satisfying Patients – One Hospital at a Time

Welcome to the new paradigm in healthcare, where patient satisfaction drives revenue and profit for care providers. Center for Medicare & Medicaid Services (CMS) is set to enforce its “value-based purchasing program (VBP)”, making full incentive payments to hospitals that achieve a high standard of quality care and patient satisfaction, while decreasing payments to underperforming hospitals. To help drive these historic changes, CMS will invest up to $1 billion and allocate an estimated $850M in FY 20131 to hospitals based on their overall performance. Under this new policy, CMS expects that 50% of hospitals will see an increase in net payments resulting from meeting the defined performance measures in quality and patient satisfaction standards, while the remaining 50% of hospitals will see a net reduction in their Medicare payments for not meeting these standards.

Addressing the issues and impacts this policy will have on hospital patient care and on medical technology manufacturers, our exclusive interview with Dr. Claire Pomeroy, CEO, UC Davis Health System, UC Davis Vice Chancellor for Human Health Sciences, and Dean, School of Medicine, offers a unique perspective on how one leading hospital is refocusing its practices in response to the new CMS payment policy.

To find out what The MarkeTech Group consultants can do to put the latest planning and technology services to work for you, visit our Website at www.themarketechgroup.com

CASE STUDY:Customer Satisfaction & Loyalty Assessment TheCompany:Agloballeaderinsurgicaltechnologyandinnovator

in procedural improvements across surgical disciplines wanted toreceivefeedbackfromitscustomersonhowtheCompanywasper-formingitskeybusinessprocesses.

TheChallenge:Todevelopanunbiasedbaselineassessmentofper-

formanceandtoestablishalongitudinalcustomersatisfactiontrack-ingprogramadministeredonanannualbasis.

OurSolution:DevelopedImportance/SatisfactionplotsforRelationalSatisfaction,NetPromoterScore(NPS)for InteractionalSatisfaction,andPerceptualMapsforClientvs.Competitorpositioning.

The Impact: Results exposed weaknesses that could potentially beexploitedbycompetitors;amulti-yearsurveyvehiclewasvalidatedandstrategicstrengthstoreinforceforsalessuccesswereidentified.

http://www.themarketechgroup.com/doc/device_diagnostics/casestudy_82.pdf

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Spring 2012VOLUME 12, ISSUE 1

The MarkeTech Group, LLC © 2012

Laws & Regulations: Medicare Incentive ProgramMedicare’s Hospital VBP program was established by the Affordable Care Act of 2010, which required the Department of Health and Human Ser-vices to create a set of quality measures for inpatient hospitals.

Overview of the Medicare Incentive Program:

The incentive-based CMS payment program goes into effect October 1, 2012.

Hospitals will be measured based on a performance score made up of 70% clinical quality and 30% patient satisfaction measures.2

Medicare will withhold 1% of its DRG payments to hospitals in order to fund the incentive payments to high-achieving hospitals based on achiev-ing certain quality and satisfaction scores. Underperforming hospitals will see their Medicare payments initially decrease by 1% and up to 2% by 2017.3

Eligibility:

To be eligible for the CMS incentive payments, hospitals will be required to report a minimum of 4 VBP measures with a minimum of 10 cases per measure, and provide results on at least 100 HCAHPS surveys.4

Calculating Patient Satisfaction Scores:

The first component of patient satisfaction will be calculated using HCAHPS survey responses from each hospital to calculate an achievement and im-provement score for 8 satisfaction measures: nurse communication, doctor communication, cleanliness and quietness, responsiveness of hospital staff, pain management, communication about medications, discharge informa-tion, overall rating.

The second component of the patient satisfaction score is a “Consistency Score” which recognizes consistent achievement across all 8 measures listed above.

Sources:

http://www.hhs.gov/news/press/2011pres/04/20110429a.htmlhttp://blogs.wsj.com/health/2011/11/08/informed-patient-tying-hospital-payments-to-patient-satisfac-tion/http://www.idsociety.org/Hospital_Value_Based/ http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/Downloads/FY-2013-Program-Frequently-Asked-Questions-about-Hospital-VBP-3-9-12.pdf

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THE ASSOCIATE CORNER: Practical Applications of PatientExperience ProgramsOne example of a highly effective patient experience program is a Pediat-ric Emergency Department (PED) in Florida that had a dramatic increase in Press-Gainey scores, staff satisfaction, and a 40% increase in patient volume as a result of a patient experience design program during new construction. The design included consideration of positive distraction ele-ments and improved privacy without adversely impacting clinical flow; for instance, a glass wall of an imaging suite creates an open and inviting feel, but can electronically be switched to be opaque for privacy.

The newly-designed PED is rated in the high 90’s for cleanliness, while an adjacent ED with identical cleaning schedule and staff, gets lower scores for cleanliness. The actual bioburden is probably identical, so the score differences, which are driven by perception and not data, are based purely on design-driven elements. Shortly after opening the new PED, turnover statistics improved 25-40%, and Press-Gainey scores became the highest in the country for a PED.

With reimbursements tied to HCAHPS, there can be additional financial return on the investment and we expect these will tip the investment deci-sions. An objective outside assessment of the patient experience can often identify incremental low-hanging fruit like:

Signage and way-finding improvementsDeclutteringConsidering behavioral impacts versus just interior decorating:

does your waiting area allow patients to choose privacy or a more public space so they can choose the level of socializing they want to do on that visit?

Is patient privacy addressed? Can they move from a dressing area to a treatment area with modesty?

The challenge is to have the expertise to know what changes to make - the measurement of HCAHPS or Press-Gainey scores does not tell you this!

Janet Ensign, Patient Experience Marketing Manager, Philips Healthcare

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Satisfying Patients – One Hospital at a Time

The MarkeTech Group, LLC © 2012

HOT TREND

ON THE HORIZON: Future of VBP Program

HIGHLIGHTSA 2010 study by the NEJM showed that value-based payments did not decrease death rates among the 252 hospitals that participated in the trial program.5

Patient Satisfaction Directors are a new role being filled at hospitals.

AT STAKE!There is concern among some hospitals that the CMS incentive-based programs favor hospitals with larger budgets that can afford greater amenities that influence patient satisfaction, resulting in some hospitals receiving lower reimbursement on things they cannot necessarily control.6

Subjective measurements may entice hospitals to try to “game the system” by influencing patients’ memories by instructing the staff to repeat phrases used in the post-discharge surveys.7

Ratings system may hurt hospitals that handle many complex cases.

Hospitals are also concerned with receiving lower reimbursement due to patients in different parts of the country giving different ratings to their hospital experiences, as reported by a Kaiser study in 2010.8

SO WHAT?CMS’ initiative represents a step in the right direction by incentivizing a patient-centric attitude among providers for both communication and care delivery methods. Medical technology manufacturers can help by improving ease of use and ergonomics, and by rethink-ing process workflows to continuously improve the patient experience.

The message seems clear: no technology will be a substitute for compassionate care and human touch, but technologies should enhance people-centered healthcare.

Sources:

http://www.kansascity.com/2012/03/28/3520686/study-paying-hospitals-based-on.htmlhttp://www.nytimes.com/2011/11/08/health/patients-grades-to-affect-hospitals-medicare-reimburse-ments.html?pagewanted=allhttp://www.nytimes.com/2011/11/08/health/patients-grades-to-affect-hospitals-medicare-reimburse-ments.html?pagewanted=allhttp://www.kaiserhealthnews.org/Stories/2011/November/08/patient-satisfaction-table.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn+%28All+Kaiser+Health+News%29

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of the Semester:Claire Pomeroy, M.D., M.B.A., Chief Executive Officer, UC Davis Health System, UC Davis Vice Chancellor for Human Health Sciences, and Dean, School of Medicine Q: How important has measuring patient satisfaction been to the UC Davis Health System prior to the announcement by CMS of its new value-based purchasing program?A: Patient Experience is one of our highest priorities. We believe that measurement is essential to improvement and we are deeply committed to measuring patient satisfaction.

We’ve been performing formal patient satisfaction measurement for more than 30 years, especially with the more robust new tools available in the last 10 years. Each year we conduct over 21,000 patient satisfaction interviews, and use multiple tools, including HCAHPS, since 2008 for both in- and out-patient. However, measurement is just the first step. We need to communicate the information to our doctors and nurses and then take action based on the information. The measurement of patient satisfaction is absolutely essential to improving quality of care with the measurement of the right metrics.

Q: How does Medicare’s new incentive based payment program affect how UC Davis Health System is approaching patient satisfaction scores? A: We’ve long measured patient satisfaction with many of the same metrics that CMS requires, so the metrics have stayed much the same. However, they are always evolving and changing to identify new pertinent indicators. They have helped us identify if we are delivering the correct medication in a timely manner, if we are reducing healthcare-associ-ated infections, if we are reducing pre-op procedures.

Q: What benefits does the new payment program offer hospitals and the healthcare industry as a whole?A: The CMS program will encourage and incentivize all hospitals, and the entire healthcare industry outside of the hospital, to put in effort to identify the most efficient ways to deliver care: figure out what is the right thing to do for the right people at the right time, not just doing more. Importantly, also figuring out what NOT to do! By reimbursing the right things, everyone in healthcare, not just the hospitals, but also manufacturers and insurers, will work towards the same end as the healthcare providers.

Q: On the other side, what challenges are there with the new payment program for hospitals and the healthcare industry as a whole? A: Collecting the data is very expensive. It requires skilled personnel, and there is a significant up-front administrative cost that does not add immediate value. Smaller hospitals may not have adequate infrastructure to collect the data – will these hospitals therefore be penalized when they are the ones who most need the investment?

Q: How can Medical Manufacturers help hospitals achieve their goals to benefit from Medicare’s incentive programs?A: We need to work hand-in-hand to develop user-friendly technologies like the automatic smart pumps and bar-coding of medications. Second, the Manufacturers can help hospi-tals identify best practices across real-life hospital settings. Third, we can measure what we do now, but to be really effective, we need to consider the next thing, to innovate and continue to pursue the next thing... and the next thing... that can improve the service we provide.

Long version of this interview: http://www.themarketechgroup.com/doc/minutes/tmtg-min31-Pomeroy.pdf

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