The HCAHPS and Competency Connection
HealthStream, Inc.
OBJECTIVES:
• Understand the HCAHPS
initiative and VBP
• Identify key components of
HCAHPS that are linked to
competency
• Explore the impact of
competencies on HCAHPS
performance
• Discover how to select appropriate
competencies
• Learn how to standardize
competency selection process
• Uncover ways to promote
employee accountability
HealthStream’s
VISION
To improve the quality of healthcare
by assessing and developing the people
that deliver care.
Insights Online
HCAHPS Impact Report
Learning Platform
Measurement
Learning
Insight
Action
through through
Research Learning
VBP Report Card
Improved
Performance
Call Center
Improvement Courseware
Understanding the HCAHPS Initiative and Value
Based Purchasing
What is CAHPS?
Consumer Assessment of Healthcare Providers and Systems
H-CAHPS: Hospital Inpatients
HH-CAHPS: Home Health Patients
CG-CAHPS: Physician Clinic & Group Office Patients
ICH-CAHPS: In-Center Hemodialysis Patients
LTC-CAHPS: Nursing home residents and family
members
• More to come!
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Differences in Survey Question
Scales
Overall, how would you rate the care you received?
Very Good
53%
Good
Fair
Poor
22%
14%
9%
Very Poor
2%
During this hospital stay, how often did nurses explain things in a way
you could understand?
Always
Usually
Sometimes
Never
40%
25%
25%
5%
The H-CAHPS Survey
• Six Domains
• Communication with nurses
• Communication with doctors
• Responsiveness of hospital staff
• Pain management
• Communication about medicines
• Discharge information
• Two Individual Questions
• Cleanliness of hospital
• Quietness of hospital
• Two Overall Questions
• Overall hospital rating (0 – 10 point scale)
• Would recommend (4 point scale-definitely yes)
HCAHPS USES
FREQUENCY
SCALE:
Always
Usually
Sometimes
Never
Data Adjustments
CMS will take the data collected and adjust
for…
• MODE: type of methodology used (phone vs. mail vs. mixed)
• PATIENT MIX: Service line, age, education, health status, language
spoken in home, time since discharge, etc.
Public Reporting of H-CAHPS Results
How often did nurses communicate well with patients?
www.hospitalcompare.hhs.gov
Patient Protection and Affordable
Care Act
VBP: Value Based Purchasing Program
• Enacted March 23, 2010
• Repealed January 19, 2011
• A specified percentage (1-2%)
of hospital payments will be
conditional on performance
• Critical Access Hospitals were not previously
required to participate in HCAHPS
Value Based Purchasing (VBP)
• CMS released VBP details January 7, 2011
• A percentage of a hospital’s base DRG rate is impacted
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Reimbursement FY2013:
Reimbursement FY2014:
Reimbursement FY2015:
Reimbursement FY2016:
Reimbursement FY2017+:
1.00% of payments
1.25% of payments
1.50% of payments
1.75% of payments
2.00% of payments
70% of reimbursement based on 15 clinical and outcome measures
30% on HCAHPS survey results
MBQIP
Medicare Beneficiary Quality Improvement Project
• Office of Rural Health Policy (ORHP):
“This initiative takes a proactive approach to ensure CAH’s
are well prepared to meet future quality requirements.”
• September 2012 – Phase II Began – included HCAHPS
• “Voluntary”
Identifying Key Components of HCAHPS
Linked to Competency
The H-CAHPS Survey
• Six Domains
• Communication with nurses
• Communication with doctors
• Responsiveness of hospital staff
• Pain management
• Communication about medicines
• Discharge information
• Two Individual Questions
• Cleanliness of hospital
• Quietness of hospital
• Two Overall Questions
• Overall hospital rating (0 – 10 point scale)
• Would recommend (4 point scale-definitely yes)
HCAHPS USES
FREQUENCY
SCALE:
Always
Usually
Sometimes
Never
Hospitals Nationally Are
Achieving High Scores
Top Box Results from the CMS National Database
(2nd Quarter 2011 Release)
Discharge Information
81%
Willingness to
Recommend
68%
Doctor
Communication
80%
Overall Rating of
Hospital
66%
Nurse Communication
75%
Responsiveness of
Staff
63%
Cleanliness of Room /
Bathroom
70%
Communication
about Medicines
59%
Pain Management
69%
Quietness
57%
HCAHPS Overall Performance
Date
Jul `07 - Oct `07 - Jan `08 - Apr `08 - Jul `08 - Oct `08 - Jan `09 - Apr `10 Jun `08 Sep `08 Dec `08 Mar `09 Jun `09 Sep `09 Dec `09 Mar `11
Change
over 2
years
Hospital Count
3,711
3,746
3,765
3,766
3,775
3,773
3,792
3,798
Nurse Communication
74%
74%
74%
74%
75%
75%
75%
76%
2%
Doctor Communication
80%
80%
80%
80%
80%
80%
80%
80%
--
Responsiveness of Hospital Staff
62%
62%
62%
62%
63%
63%
63%
64%
2%
Pain Management
68%
68%
68%
68%
68%
69%
69%
69%
1%
Communication About Medicines
59%
59%
59%
59%
59%
59%
60%
60%
1%
Cleanliness of Room/Bathroom
Quietness of Area Around Room at
Night
69%
69%
69%
70%
70%
70%
70%
71%
2%
56%
56%
56%
56%
57%
57%
57%
58%
2%
Discharge Information
80%
80%
80%
80%
81%
81%
81%
81%
1%
Overall Rating of Hospital
Willingness to Recommend
Hospital
64%
64%
64%
65%
65%
66%
66%
67%
3%
68%
68%
68%
68%
68%
68%
69%
69%
1%
HCAHPS Composite
68%
68%
68%
68%
69%
69%
69%
70%
2%
Exploring the Impact of Competency on
HCAHPS
Linking Employee and Physician
Satisfaction and Competency
to HCAHPS Results
Results of a Recent Multivariate Study: Employee and Physician
Predictors of HCAHPS Scores:
What factors/variables predict HCAHPS scores?
Methodology
Sample:
The sample included 237 HealthStream client
hospitals.
Data used were employee satisfaction scores,
physician satisfaction scores and HCAHPS
inpatient scores. Total Beds and Average Length of
Stay were obtained from an external data source.
Methodology
• A multiple regression analysis was conducted on the data.
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Independent (predictor) Variables:
Employee Ratings of Administration
Employee Ratings of Immediate Supervisor
Employee Satisfaction/Loyalty
Physician Ratings of Administration
Physician Ratings of Hospital Efficiency
Physician Ratings of Nursing Skill
Total Beds
ALOS
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Dependent Variable:
HCAHPS Overall Hospital Score
Summary of HCAHPS Predictors
Three variables significantly predicted HCAHPS scores:
Standardized
Beta
Significance
Employee Satisfaction & Intent to Stay
.78
p<.001
Employee Perceptions of Upper Management
-.46
p<.001
Physician Perceptions of Nursing Skill
.27
p<.001
Significant Predictors
Implications
• Employee satisfaction/loyalty and HCAHPS scores
• Employee satisfaction is critical to inpatient care
• Physician rating of nursing skill and HCAHPS scores
• Importance of physicians’ perceptions of nursing skill
• Employee ratings of administration and HCAHPS
scores
• This unexpected finding can help administrators understand
potential low employee administration ratings in the quest
toward HCAHPS improvement efforts
Questions?
Kylie B. Taylor
Regional Director
(443) 744-0299
kylie.taylor@healthstream.com