The Quest for “Always”
Nursing Excellence Conference
April 19,2013
Objectives
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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
HCAHPS

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Hospital Consumer Assessment of
Healthcare Providers and Systems
Other surveys:
 CAHPS®
 HHCAHPS
 CG-CAHPS
Overview of HCAHPS
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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:

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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 (Payfor-Performance)
Increase overall accountability
HCAHPS Timeline
Inpatient Perspective
Payment System (IPPS)
HCAHPS survey
endorsed by
National Quality
Forum
Reimbursement
Dollars are at
Risk $$$
2005
2002
Value Based
Purchasing
Incentive
Payments
2006
CMS partners with
AHRQ to develop
HCAHPS survey
October 2006, CMS implements
HCAHPS survey
2008
2010
2012
First public
reporting on
HCAHPS
Patient Protection and
Affordable Care
HCAHPS Survey Process

Survey design

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
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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

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
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Mail
Telephone
Mail with telephone follow-up
Active Interactive Voice Response (IVR)
HCAHPS Survey Process
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Inclusions for survey

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Adult patients (18 years and older)
Medical, Surgical or Maternity care
Overnight stay or longer
Alive at discharge
Exclusions from survey

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
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Pediatric patients
Psychiatric patients
Hospice discharges
Prisoners or law enforcement patients
Patients discharged to nursing homes and skilled
nursing facilities
No Publicity patients
HCAHPS Experience of Care Dimensions
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Communication with Nurses
Communication with Doctors
Responsiveness of Hospital Staff
Pain Management
Communication about Medications
Hospital Environment
Discharge Information
Overall Hospital Ratings
HCAHPS Dimensions
Communication with Nurses *
Communication with Doctors
Responsiveness of Hospital Staff *
HCAHPS Questions
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Nurse Courteous and Respectful
Nurse Listens Carefully
Nurse Explains Things
Doctor Courteous and Respectful
Doctor Listens Carefully
Doctor Explains Things
Assistance to Bathroom
Response to Call Button
Pain Management *
 Pain Well Controlled
 Help With Pain
Communication About Medicines *
 Explain New Medications
 Explain New Medication Side Effects
Hospital Environment
 Cleanliness of room
 Cleanliness of bathroom
Discharge Information *
 Discharge Help
 Discharge Symptoms
Overall Hospital Ratings
 Overall Hospital Ratings
 Willingness to Recommend
* Designates Patient Care Dimensions related to the Magnet Sources of Evidence
HCAHPS Primary Rating Scale
Always
Usually
Sometimes
Never
“Always” is the only score that counts!!
HCAHPS Overall Ratings

Overall Rating of the Hospital

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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
So How Are We Doing????
HCAHPS Performance
South Carolina Results
"Percent Always"
April 2011 - March 2012
Doctors communicate well with patients
84
80
Nurses Communicate well with patients
Were the patients' rooms and
bathrooms kept clean?
73
Were patients' pain well controlled?
72
Was the area around patients rooms
kept quiet at night?
68
Did patients receive help quickly from
hospital staff?
68
Staff explanations about medications?
66
0
10
20
30
40
50
Percent "Always" Response
60
70
80
90
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?
1
Never
2
Sometimes
3
Usually
4√
Always
3. During this hospital stay, how often did nurses explain things in a way
you could understand?
1
Never
2
Sometimes
3
Usually
4√
Always
HCAHPS Performance
South Carolina Compared to National Average
April 2011 - March 2012
84
Doctors communicate well with patients
81
80
Nurses Communicate well with patients
78
73
Were the patients' rooms and
bathrooms kept clean?
73
72
Were patients' pain well controlled?
70
68
Was the area around patients rooms
kept quiet at night?
60
68
Did patients receive help quickly from
hospital staff?
66
66
Staff explanations about medications?
63
0
10
20
30
40
50
Percent "Always" Response
National Average
South Carolina
60
70
80
90
Communication about Medications
15. During this hospital stay, were you given any medicine that you had not
taken before?
Screening Question….
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?
1 Never
2 Sometimes
3 Usually
4√ Always
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.
1 Strongly disagree
2 Disagree
3 Agree
4√ Strongly agree
25. When I left the hospital, I clearly understood the purpose for taking each of my
medications.
1 Strongly disagree
2 Disagree
3 Agree
4√ Strongly agree
5 I was not given any medication when I left the hospital
Overall Ratings
HCAHPS Performance
South Carolina Results
April 2011 - March 2012
Percent of Patients Giving 9 or 10
Ratings
71
Overall Rating
69
Definitely Would Recommend
71
Willingness to
recommend
70
0
10
20
30
National Average
40
50
South Carolina
60
70
80
The Key is Improvement…..
The database is moving……
Without continual improvement we will fall behind!!
HCAHPS Summary
Overall Rating Performance
April 2010 - March 2011
8
34% of States have a 70%
or higher 9 & 10 ratings
7
7
6
6
6
Number of States
5
5
4
4
4
3
3
3
3
2
2
2
2
1
1
1
1
0
0
75
76
0
60
61
62
63
64
65
66
67
68
69
70
71
Percent 9 & 10 Ratings
Source: Summary of HCAHPS Survey Results.
HCAHPSonline.org/, CMS 3/29/2013
South Carolina = 69% 9 & 10 ratings
72
73
74
HCAHPS Summary
Overall Rating Performance
April 2011- March 2012
8
46% of States have a 70%
or higher 9 & 10 ratings
7
7
7
6
Number of States
5
5
5
4
4
4
4
4
3
3
2
2
2
2
1
1
0
0
0
0
0
60
61
62
63
64
65
66
67
68
69
70
71
72
73
Percent 9 & 10 Ratings
Source: Summary of HCAHPS Survey Results.
HCAHPSonline.org/, CMS 3/29/2013
South Carolina = 71% 9 & 10 ratings
74
75
76
So Why is HCAHPS so Important??
Value Based Purchasing
Value Based Purchasing
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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
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Performance Periods
Reimbursement dollars at risk
Value Based Purchasing –
Performance Periods
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Fiscal Year 2013 = 1.0% at risk
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Fiscal Year 2014 = 1.25% at risk
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Performance Period ( 7/1/2011 – 3/31/2012)
Performance Period (4/1/2012- 12/31/2012)
Fiscal Year 2015 = 1.5% at risk
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Performance Period (1/1/13- 12/31/2013)
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Fiscal Year 2016 = 1.75% at risk

Fiscal Year 2017 = 2.0% at risk
HCAHPS and Value Based Purchasing
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FY 2013 --1.0% at risk
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FY 2014-- 1.25% at risk
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HCAHPS (30%)
Clinical Care Processes (45%)
Outcomes (25%)
FY 2015-- 1.5% at risk
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HCAHPS (30%)
Clinical Care Processes (70%)
HCAHPS (30%)
Clinical Care Processes (20%)
Outcomes (30%)
Efficiency (20%)
Scoring
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Achievement points
Improvement points
Value Based Purchasing – Patient
Experience of Care Domain Summary
(Report Example)
Database
Dimension Score is based
on the greater of
Improvement or achievement
points
Value Based Purchasing– Key Points

We must understand that reimbursement
dollars are at risk

Budget neutral program
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Our current performance impacts future
reimbursement

All organizations are working to improve
their performance
So What Can You Do?

Understand your own organizational
HCAHPS scores http://www.medicare.gov/hospitalcompare/
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Identify areas of strengths and opportunities
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Prioritize areas of opportunity
Utilize evidence based tools (i.e. AIDET,
Rounding, etc)
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Communicate results at all levels of the
organization – “Connect the Dots” for all staff
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Celebrate and share your successes
Final Thoughts
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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
The Quest for “Always”
Questions
Sources/Links

http://www.theberylinstitute.org/?page=IMPX_VIDEO
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http://www.hcahpsonline.org/
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http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/hospital-value-basedpurchasing/Downloads/HospVBPNPC100412.pdf