(CAHPS) Experience of Care Surveys: From Design to Implementation

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Slide 1

(CAHPS® [Consumer Assessment of Healthcare Providers and Systems]) Experience of Care Surveys:
From Design to Implementation

Liz Goldstein, Ph.D.

AHRQ Annual Conference
September 9, 2012

Slide 2

The Triple Aim

Image: A screenshot of Centers for Medicare & Medicaid Services (CMS) Better Care Web site page highlights three buttons: Better Care, Better Health (Healthier people and communities), and Lowering Health Care Costs (Lower cost).

Slide 3

Patient Experience Surveys Support the Triple Aim Through Public Reporting, Pay for Performance, and Quality Improvement

Image: "Public Reporting," "Pay for Performance," and "Quality Improvement," are shown as three Ionic columns on a classical structure. The base below the columns is labeled "Patient Experience Surveys" and the triangular portico the columns hold up is labeled "Triple Aim."

Slide 4

CAHPS Surveys Measure Patient Experience, Not Patient Satisfaction

• CAHPS asks patients whether key things happened in their health care.
• Provides actionable information to improve the quality of care.
• Focus is on important aspects of care such as communication, access, coordination of care, and patient involvement.
• Less subjective than asking about satisfaction.

Slide 5

CAHPS Surveys Currently Implemented by CMS

• Hospital (HCAHPS) [Image: An "H" hospital sign is shown].
• Home Health Care (HHCAHPS) [Image: An icon of a house is shown].
• Health Plan [Image: A document with a caduceus above it is shown].
• Prescription Drug Plan [Image: Pills are shown spilling out of a medicine bottle].
• Fee-for-Service [Image: A credit card and dollar sign [$] are shown].

Slide 6

Public Reporting

Image: "Public Reporting" is shown as an Ionic column.

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Public Reporting on www.medicare.gov

"Compare" Web sites help users gain information and make decisions.

Image: A screenshot of CMS's Medicare.gov Web site is shown. Two sections are highlighted and annotated as "Links to 'Compare' Web sites" Find health & drug plans, and Find doctors, providers, hospitals, & plans.

Slide 8

Home Health Compare Provides Information About Home Health Agencies

Image: A screenshot of CMS's Home Health Compare Web site's search page is shown.

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Compare Up To 3 Agencies Simultaneously

Criteria Include...

Services Provided:

• Nursing Care.
• Physical Therapy.
• Occupational Therapy.
• Speech Therapy.
• Medical Social Services.
• Home Health Aid.

Quality of Patient Care:

• Managing Daily Activities.
• Managing Pain and Treating Symptoms.
• Treating Wounds and Preventing Pressure Sores.
• Preventing Harm.
• Preventing Unplanned Hospital Care.

And Patient Experience Survey Results...

Slide 10

Patient Experience Survey Results
Home Health CAHPS (HHCAHPS)

Percent of patients who...

Composite Measures:

• Reported that their home health team gave care in a professional way.
• Reported that their home health team communicated well with them.
• Reported that their home health team discussed medicines, pain, and home safety with them.

Global Scores:

• Gave their home health agency a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).
• Reported YES, they would definitely recommend the home health agency to friends and family.

Slide 11

Image: Image: Two boxes are shown, containing the text "Reporting HHCAHPS Results" and "Home Health Annual Payment update." The two boxes are connected by a chain. Below the boxes is the text: "No Report = Less Money".

Slide 12

Home Page for Hospital Compare

Image: A screenshot of CMS's Hospital Compare Web site's "Find a Hospital" page is shown.

Slide 13

Data Available on Hospital Compare

Image: A screenshot of CMS's Hospital Compare Web site shows sample results from a "Find a Hospital" search. The tabbed information at the top of the page is highlighted by red arrows and notes:

• General Information (General Information about Hospitals).
• Patient Survey Results (Patient Experience Data).
• Timely & Effective Care (Clinical Data).
• Readmissions, Complications & Deaths (Clinical Data).
• Use of Medical Imaging (Clinical Data).
• Medicare Payment (Administrative Data).
• Number of Medicare Patients (Administrative Data).

Slide 14

Example of Patient Experience Data Presented on Hospital Compare

• Dimensions based on patient responses to HCAHPS Surveys.
• Data used in Hospital Value Based Purchasing.
• Allows the public to see specific, detailed comparisons among providers.

Image: A screenshot of CMS's Hospital Compare Web site compares three sample hospitals.

Slide 15

Home Page for Medicare Health Plan Comparisons

Image: A screenshot of CMS's Medicare.gov Web site's "Medicare Plan Finder" page is shown.

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Summary: Number of Plans by Type in Your Area

Image: A screenshot of CMS's Medicare.gov Web site shows sample results from a "Medicare Plan Finder" search.

Slide 17

Individual Plan Entry

Image: A screenshot shows a sample individual plan from the "Medicare Plan Finder" search results. The Overall Plan Rating, shown as 4 out of 5 stars, is highlighted by a red arrow.

Slide 18

CMS Plan Ratings System

CMS created the Five-Star Plan Rating System to help consumers, their families, and caregivers compare health plans. And in the case of Medicate Advantage plans to reward high-performing plans with bonuses.

Image: The Five-Star Plan Rating is shown:

• 5 stars = Excellent.
• 4 stars = Above average.
• 3 stars = Average.
• 2 stars = Below average.
• 1 star = Poor.

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Adjustments to Patient Experience Data to Ensure Comparable Information

• Mix of patients.
• Mode of survey administration (if applicable).

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Pay for Performance

Image: "Pay for Performance" is shown as an Ionic column.

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Hospital Value Based Purchasing

• Hospital Value Based Purchasing links a portion of CMS payment to providers based on performance on a set of quality measures:
  • Hospital Value Based Purchasing established by the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148).
  • Affects payment for patients discharged October 1, 2012 (FY 2013) and forward.

Slide 22

Here is How it Works: Hospital VBP Incorporates Patient Experiences into Providers' Total Performance Score

Image: A series of text boxes shows the following process: Clinical Process Domain Score (70%) + Patient Experience Score (30%) = Total Performance Score → Payment. An arrow points up to the Patient Experience Domain Score box from Patient Experience Surveys (CAHPS).

Slide 23

HCAHPS and Hospital VBP Scoring

• Eight HCAHPS Dimensions in Hospital VBP:
  • Communication with Nurses.
  • Communication with Doctors.
  • Staff Responsiveness.
  • Pain Management.
  • Communication about Medicines.
  • Discharge Information.
  • Cleanliness & Quietness of Hospital Environment (combined).
  • Overall Rating of Hospital.
• Percent of patients who chose "Top-box" response.

Slide 24

Most Dimensions Are Composed of Individual Survey Items

Dimension: Communications With Nurses (Items 1, 2, 3):

1. During this hospital stay, how often did nurses treat you with courtesy and respect?
2. During this hospital stay, how often did nurses listen carefully to you?
3. During this hospital stay, how often did nurses explain things in a way you could understand?

Dimension: Communications With Doctors (Items 5, 6, 7):

5. During this hospital stay, how often did doctors treat you with courtesy and respect?
6. During this hospital stay, how often did doctors listen carefully to you?
7. During this hospital stay, how often did doctors explain things in a way you could understand?

Slide 25

Patient Experience Domain Score Calculation

HCAHPS Base Score

For each of the Eight HCAHPS Dimensions:

1. Achievement Points (0-10) and Improvement Points (0-9) are calculated.
2. The larger of the Improvement Points or Achievement Points for each Dimension is used.
3. Dimension scores are summed to create the HCAHPS Base Score: 0 to 80 points

Consistency Points

• 0 to 20 points.
• Target hospital's lowest performing HCAHPS Dimension during the Performance Period.
• If the lowest scoring Dimension is below the national median, then the hospital earns between 0 and 19 Consistency Points.

Max Patient Experience Domain Total Score = 100 points

Slide 26

Patient Experience Central Role in Hospital VBP

Image: A series of text boxes shows the following process:

Patient Responses to Survey Items
↓
8 Dimensions
↓
Patient Experience Domain Score
↓
30% of Total Score
↓
Payment

Slide 27

Medicare Advantage Quality Ratings

• Quality bonuses are required as part of the Affordable Care Act for MA contracts.
• CMS is conducting a demonstration to determine whether additional quality-based payments lead to more rapid and larger year-to-year quality improvements.
• Quality bonuses are based on the MA Plan Ratings.

Slide 28

Plan Ratings—Multiple Levels

Image: A chart shows the multiple levels of plan ratings:

Overall and Summary Rating (1/2 stars):

• Overall (MA-PD) or Summary (Part C and Part D).

Example Domains:

• Staying Healthy.
• Patient Safety.

Example Measures:

• Breast Cancer Screening (connected to "Staying Healthy" above by a solid line and "Overall (MA-PD) or Summary" by a dotted line): 75% screened.
• Annual Flu Vaccine (connected to "Staying Healthy" above by a solid line and "Overall (MA-PD) or Summary" by a dotted line): 75% vaccinated.
• High Risk Med (HRM) Use (connected to "Patient Safety" above by a solid line and "Overall (MA-PD) or Summary" by a dotted line): 10% members receive HRM.

Slide 29

9 Domains of Plan Ratings

Ratings of Health Plans (Part C):

• Staying healthy: screenings, tests, vaccines,.
• Managing chronic (long-term) conditions.
• Member experiences with their health plan.
• Member complaints, problems getting services, and choosing to leave the plan.
• Health plan customer service.

Ratings of Drug Plans (Part D):

• Drug plan customer service.
• Member complaints, problems getting services, and choosing to leave the plan.
• Member experience with plan's drug services.
• Drug pricing and patient safety.

Slide 30

Sources of Data for Plan Ratings

1. Surveys (CAHPS Surveys and Health Outcomes Survey).
2. Clinical Data (Healthcare Effectiveness Data and Information Set, HEDIS).
3. CMS administrative data.
4. Data collected by CMS contractors.

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Quality Bonus Payments Under Current Law and CMS Demonstration

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Quality Improvement

Image: "Quality Improvement" is shown as an Ionic column.

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Quality Improvement

• Plan/provider quality improvement (QI) strategies should focus on improving overall care that enrollees/patients are receiving across the full spectrum of services.
• QI strategies should not be limited to only the measures included in the public reporting and VBP initiatives.

Slide 34

Incentives for Quality Improvement

• Public Reporting.
• Value-based Purchasing.

Slide 35

High Performer Icon for Plans

• CMS highlights contracts receiving a rating of 5 stars with this icon:
  This plan got Medicare's highest rating (5 stars).
• Information on Medicare.gov notes that beneficiaries can enroll in 5-star contracts at any time during the year.

Slide 36

Low Performer Icon for Plans

• Since 2011, CMS has marked contracts rated less than 3 stars with a low performer icon:
  
• Beginning this fall, beneficiaries will be unable to use MPF to enroll in these contracts.
• MPF messaging and 1-800 Medicare representatives will also discourage enrollment into these contracts.

Slide 37

Examples of Tools for Quality Improvement

• Medicare Plan Reports.
• CAHPS Quality Improvement Guide.

Slide 38

Excerpt from Health Plan Report to Use for Quality Improvement

Image: A screenshot of the report excerpt shows responses to the Health Plan Composite Measure, Overall Health Plan Ratings, Medicare-Specific and HEDIS Measures, and New Single Item Measures.

Slide 39

Plan Report Points Out Strengths and Opportunities For Improvement

Image: A screenshot of the report excerpt shows responses to the Health Plan Composite Measure, Overall Health Plan Ratings, Medicare-Specific and HEDIS Measures, and New Single Item Measures.

Slide 40

Recent Updates

Slide 41

Recent Enhancements to CMS Patient Experience Surveys

• Care Transitions measures added to Hospital CAHPS starting July 2012 on a voluntary basis and January 2013 nationally.
• Care Coordination items added to Medicare health plan survey in early 2012.

Slide 42

Future Directions

• In-Center Hemodialysis CAHPS.
• Accountable Care Organizations.
• Health Insurance Exchanges.
• Medicaid Home and Community-Based Services.
• Hospice.
• Emergency Room.
• Outpatient Surgical.