HCAHPS: How Pharmacists can
Impact Patient Experience
Meghan E. Tolan, PharmD, MBA Candidate
PGY2 Health System Pharmacy Administration Resident
The Johns Hopkins Hospital
Disclosure
• I have no relevant financial relationships
or commercial interests to disclose for
this presentation.
Objectives
• Summarize the purpose and goals of
the HCAHPS survey
• Describe the relationship between
HCAHPS performance and CMS
reimbursement
• Identify how pharmacists can impact
patient experience in the hospital setting
Pre-Assessment
Which of the following survey questions can
pharmacists impact through direct patient
care?
A. How often was your pain well controlled?
B. How often did hospital staff describe possible
side effects in a way you could understand?
C. When I left the hospital, I clearly understood
the purpose for taking each of my
medications.
D. A, B and C
Customer Experience
The Institute for Healthcare
Improvement Triple Aim
Available from: http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx. Accessed 2015 Sept 1.
HCAHPS Survey
• Hospital Consumer Assessment of
Healthcare Providers and Systems
• Consists of 32 standardized questions
• Used to measure experience of adult
inpatients with an overnight stay
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
Purpose of HCAHPS
• Drive to establish national standards for
comparing patient perceptions of care
• Way to uniformly measure and publicly
report patients’ perspectives on their
inpatient care
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
Goals of the HCAHPS Survey
1. Produce comparable data on patients’
perspectives of care that allows objective and
meaningful comparisons between hospitals on
domains that are important to consumers
2. Create incentives for hospitals to improve their
quality of care
3. Enhance public accountability in health care
by increasing transparency of the quality of
hospital care provided in return for the public
investment
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
HCAHPS Survey Instrument
CMS Rules: Communicating with
Patients about the HCAHPS Survey
• Hospitals can inform patients that they may receive a
survey after discharge
• To prevent bias of survey results, hospitals CANNOT:
–
–
–
–
Post or hand out copies of the survey
Ask patients any HCAHPS questions
Encourage patients to answer questions in a particular way
Indicate that the hospital’s goal is for all patients to rate them
as a “10,” “Definitely yes,” or an “Always”
– Imply anyone will be rewarded for positive feedback from
patients
– Ask patients to explain why they did not rate a hospital with
the most favorable rating possible
– Offer incentives of any kind for participation in the survey
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
HCAHPS Public Reporting
• Reported four times each year
• Lag time for CMS reporting
• CMS adjusts results to create “level
playing field”
– Adjustments made for mode and patient
mix
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
Reporting of HCAHPS Scores
• Hospital Compare
– http://www.medicare.gov/hospitalcompare
Available from: http://www.medicare.gov/hospitalcompare/search.html. Accessed 2014 Oct 17.
Top-Box Response
Survey Question
Scale
Top-Box
During the hospital stay, how often was your
pain well controlled?
Never,
Sometimes,
Usually, Always
Always
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?
0-10
9 or 10
When I left the hospital, I clearly understood the Strongly
Disagree,
purpose for taking each of my medications.
Disagree, Agree,
Strongly Agree
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
Strongly
Agree
HCAHPS Star Ratings
Image: http://datascience.berkeley.edu/wp-content/uploads/2014/02/Star-Rating.jpg
CMS Reimbursement
Implications
• Inpatient Prospective Payment
System (IPPS)
• Value Based Purchasing (VBP) in
49 states and Washington D.C.
• Quality Based Reimbursement
(QBR) in Maryland
Value Based Purchasing
• CMS initiative
• Established by The Patient Protection
and Affordable Care Act of 2010
• Rewards hospitals with incentive
payments for quality of care
• Applies to Medicare and Medicaid
patients
Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.
Financial Drivers (FY 2016)
Outcomes
Patient Experience
Efficiency
Clinical Processes
10%
25%
25%
40%
Value Based Purchasing
Available from: http://www.stratishealth.org/documents/FY2017-VBP-fact-sheet.pdf. Accessed 2015 Sept 1.
HCAHPS and Pharmacists
How does HCAHPS affect the way I take
care of my patients?
• Pain Management
• Patient Education
• Transitions of Care
HCAHPS Survey Questions
Directly Impacted by Pharmacists
Identified by Johns Hopkins Hospital Department of Pharmacy
• Q13: During this hospital stay, how often was your pain well
controlled?
• Q14: During this hospital stay, how often did the hospital staff do
everything they could to help you with your pain?
• Q16: Before giving you any new medicine, how often did
hospital staff tell you what the medicine was for?
• Q17: Before giving you any new medicine, how often did
hospital staff describe possible side effects in a way you could
understand?
• Q25: When I left the hospital I clearly understood the purpose
for taking each of my medications.
Additional questions are still important!
Pharmacist-Driven Initiatives
at Johns Hopkins Hospital
• Care Coordination Services
• Teach Back Competency
• “2 Patients per Day” Initiative
• Learner Huddle
• Pharmacy Ambassador Program
• SMART Goal
Department of Pharmacy
HCAHPS Scorecard
At or above 75th percentile compared to entire nation
At least 3 percentage points improvement over last year (compared to “FY 2014 Baseline”)
Below 75th percentile nationally & < 3 percentile improvement
Looking Ahead
•
•
•
•
•
HHCAHPS (Home Health)
CGCAHPS (Outpatient)
EDCAHPS (Emergency Department)
Pediatric CAHPS
Surgical CAHPS
Post-Assessment
Which of the following survey questions can
pharmacists impact through direct patient
care?
A. How often was your pain well controlled?
B. How often did hospital staff describe possible
side effects in a way you could understand?
C. When I left the hospital, I clearly understood
the purpose for taking each of my
medications.
D. A, B and C
Key Takeaways
• Nationally, there is an increased focus
placed on patient experience quality
measures
• If we aim to improve patient experience
and the care we provide, scores will
follow
Acknowledgements
• Kimberly Sparks, Service Excellence
• Jacob Smith, PharmD, MBA, Assistant
Director of Quality Improvement and
Regulatory Affairs
• Todd Nesbit, PharmD, MBA, Director of
Pharmacy Patient Care Services
Questions?
Image: http://www.clinicallinkages.com/wp-content/uploads/2014/03/HCAHPS-Zoomed-In-2.jpg