The path to patient experience excellence

The Path Excellence January 2014 BLOG POST

to

Patient

Experience

Why Patient Experience (PX) is Important to U.S. Hospitals Patient experience has become an important topic for U.S. hospitals for a variety of reasons, including a recently introduced system of incentive payments and penalties from CMS called Hospital Value-Based Purchasing (VBP). The purpose of the VBP program is to promote better clinical outcomes for patients and improve their experience of care during hospital stays. Therefore, it is paramount for hospitals to focus efforts on improving patient experience as well as the other clinical factors associated with the program, to maximize their incentive payments and to avoid penalties.

The legislation uses the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and clinical process of care, or core measures, to calculate value-based incentive payments to hospitals. For FY2013, CMS will reduce base operating diagnosis-related group (DRG) payment to all hospitals reimbursed under the Inpatient Prospective Payment System (IPPS) model by 1% (increasing to 2% by FY2017).

Timeline of Payment Initiatives 2013: Readmissions Reduction Program reduces base operating inpatient DRG payments for hospitals that has higher-than-expected readmissions for AMI, heart failure and pneumonia 2013: Physician Quality Reporting System pay-for-reporting requirement for certain medical practices 2015: Hospital-Acquired Conditions (HAC) program planned implementation, reducing base operating inpatient DRG payments for the 25% of hospitals with the highest rate of certain HACs 2015: Physician VBP planned implementation 2016: Meaningful Use shifts from its incentive phase to its penalty phase for both eligible hospitals and eligible professionals

The State of Patient Experience1: •

Patient Experience remains the top priority among American hospitals and hospital systems, again this year as it was two years ago

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Mandates for action have slipped while formal support structures and formal definitions (targets) are on the rise

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Hospital professionals continue to be optimistic (cautiously & realistically) about the progress being made to improve the Patient Experience

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Hospitals typically address the PX with committees or teams, but there is an increasing trend toward delegating this responsibility to a dedicated Leader. Though time commitment still wavers

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Tactical change is underway and focused on a few key issues, including better communication, reduced noise levels, and improving the discharge process

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The Beryl Institute

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Support from senior leadership continues to be the biggest driving force in supporting PX efforts, and distracted leadership now the biggest roadblock

Top Priorities to Improve Patient Experience: According to the Beryl Institute, the areas where hospitals are currently focusing are reducing noise, increasing patient rounding (doctors checking in on patients more often), improving discharge process & instructions Responsiveness of Staff/Communication and Pain Management. However, the most recent HCAHPS data findings reveal that focusing on these specific areas at the expense of others can have a limited effect on patients’ recommendation to friends and family.

Drivers for Improving Patient Experience: •

Strong, visible support “from the top”

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Having clinical managers who visibly support Patient Experience efforts

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Formalized process review & improvement focused on Patient Experience

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Formal Patient Experience structure or role

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Ongoing “internal communications” push

Obstacles in improving Patient Experience: •

Leaders appointed to drive Patient Experience pulled in too many directions

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Other organizational priorities reduce emphasis on Patient Experience

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General cultural resistance to doing things differently

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Lack of support from physicians

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Lack of sufficient budget or other necessary resources

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How Reliable are Patient Experience Surveys As physician and hospital compensation becomes increasingly tied to patient feedback, health care providers and academics are raising strong objections to the use of patient-experience surveys. These views are fueled by studies indicating that patient-experience measures at best have no relation to the quality of delivered care and at worst are associated with poorer patient outcomes.

Major Concerns about Patient Reported Measures, Particularly Those Assessing “Patient Experience” •

Patient feedback is not credible because patients lack formal medical training Patient satisfaction measures actually capture some aspect of “happiness,” which is easily influenced by factors unrelated to care. Some analysts have found that overall satisfaction with care is positively correlated with clinical adherence to treatment guidelines. One explanation for this correlation is that patients base their satisfaction rating on an accurate “sense” of the quality of technical care. That would make patient-experience measures and clinical adherence measures redundant, which might imply that patient feedback has no additional value, but then the concern about credence would be meritless. Another explanation is that the measures used to capture patient satisfaction reflect interpersonal care experiences, such as patient–provider communication, which correlate with technical care but represent a unique dimension of quality. Patient-reported measures not only are strongly correlated with better outcomes but also largely capture patient evaluation of care-focused communication with nurses and physicians, rather than non-care aspects of patient experience, such as room features and meals.

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Patient Experience measures could be confounded by factors not directly associated with the quality of processes Some observers believe that patients base their assessment of their experience on their health status, regardless of the care they've received. However, if feedback is determined by outcome, there should be no correlation between patient-experience measures and outcome when analyses control for clinical adherence. Some studies have already shown such correlations in multiple data sources in relation to multiple disease conditions, which indicate that patient-experience measures don't simply reflect clinical adherence–driven outcomes but also represent a different dimension of quality that is otherwise difficult to measure objectively.

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Patient Experience measures may reflect fulfillment of patients' a priori desires Some studies have pointed that patient-experience measures and the volume of services ordered are not correlated; in fact, increased patient engagement leads to lower resource use but greater patient satisfaction.

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Although there are unresolved methodological issues related to the measurement and interpretation of patient experiences, regarding survey content, risk adjustment, and the mode and timing of survey administration. But in the end, the center of discussion should be on how to improve patient experiences by focusing on activities (such as care coordination and patient engagement) found to be associated with both satisfaction and outcomes, evaluate the effects of new care-delivery models on patients' experiences and outcomes, develop robust measurement approaches that provide timely and actionable information to facilitate organizational change, and improve data-collection methods and procedures to provide fair and accurate assessments of individual providers.

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