HCAHPS Reveals What Patients Really Think

No longer will patient satisfaction data be private. HCAHPS will give savvy healthcare consumers more information than ever before. What do you need to know, and how much time do you have to prepare?

Patient Satisfaction Goes Public

According to a HealthLeaders magazine survey earlier this year, 99% of hospitals are currently measuring patient satisfaction. Most are satisfied with the overall effectiveness of their surveys. They trust their results, place a high value on patients' perceptions, and in an increasing number of facilities, they even hold management accountable by including incentives based on scores.

So why is the U.S. government stepping in? Until now, patient satisfaction results were owned by the hospitals, and they didn't have to share the information if it was unfavorable. The Centers for Medicare & Medicaid Services (CMS) has developed a new survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (or HCAHPS, for short) to increase the accountability and transparency of healthcare delivery practices. It is the first public, standardized survey providing an apples-to-apples comparison.

Accountability & Motivation

Starting in March 2008, results will be posted on a publicly available web site (www.hospitalcompare.hhs.gov) along with other clinical measures to give patients a more complete view of the quality of the hospitals competing for their business. Consumers accustomed to shopping around for the best new car or for the best local restaurant will be able to see how their local hospital stacks up with respect to heart failure rate and nursing courtesy.

Beginning with July 2007 discharges, acute care hospitals that do not fully participate in HCAHPS will not receive their full IPPS Medicare annual payment update for fiscal year 2008. Since, according to the AHA, hospitals are already coping with a more than $25 billion shortfall in CMS reimbursements, they can hardly refuse to play along.

Fortunately, the transition should be relatively smooth. According to the HealthLeaders survey, 91% of hospitals are currently partnering with a 3rd party patient satisfaction survey company. All of the major players in this market are approved to administer HCAHPS for their clients, so for many hospitals, the implementation will be seamless.

Drawbacks

The information provided by HCAHPS will be helpful to patients, but for most hospitals, it does not go far enough as a useful tool to measure and improve performance. There are several disadvantages of HCAHPS as compared to the major 3rd party surveys. Here are just a few:

A major drawback to HCAHPS is that it measures only the basic elements of patient care, excluding other factors important to patients' perceptions, which influence their willingness to recommend the hospital. One major item is the hospital's appearance. HCAHPS includes only one question: "During this hospital stay, how often were your room and bathroom kept clean?" (Never/Sometimes/Usually/Always)

This question has several limitations. It does not measure the level of cleanliness, only the frequency of cleaning, which can be misleading. For example, if a housekeeper visits the room three times a day, is that considered "usually" or "always"? What if the housekeeper makes frequent visits to tidy up a room, but the patient is asleep or out for testing or procedures?

Crothall Can Help

The key to improving scores for this question is raising patient awareness that the cleaning is taking place and the patient's needs are being fully met. Crothall's hospitality program addresses this goal. Housekeepers are thoroughly trained on hospitality techniques that include greeting the patient, explaining what will be done in the room, and asking if there are any specific requests, always with a focus on courtesy. Tools such as "while you were out" cards and V-tip toilet tissue folds indicate a cleaning has been completed even in the patient's absence. Rounds conducted by the Environmental Services manager further enforce the hospital's dedication to meeting the patient's needs.

Crothall's techniques have been effective. At Hahnemann University Hospital, a Tenet facility, which has been using the HCAHPS survey since 2005, the Crothall-managed Environmental Services department has steadily increased scores for the cleaning question, from 65% to 81% of patients responding "Always." This is substantially higher than the national average.

Whether HCAHPS will succeed in meeting its ambitious goals is uncertain. But patient satisfaction data will soon be made public, and patients will be more empowered than ever before to make informed decisions about where to go for their healthcare needs. Is your hospital ready?