MedCAHPS Analysis & Plan_May 14 2012

Mitotel Inc. 620 Newport Center Drive, CA 92660 T 949-760-5333 www.mitoterl.com

MedCAHPS

ANALYSIS and PLAN

Presented to: Jack Hakim and Tim May with EC Wise and the MEDCAHPS Stakeholders including CRGMedical, PSO Services Group, InfoTool, RWD and GP Strategies

Prepared by: Bret Rahn.

Concept Version Tuesday, May 15, 2012

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MedCAHPS Needs Analysis Outline 1. Purpose of MedCAHPS

2. Target Audiences

3. Competition

4. Competitive Advantages

5. CAHPS and HCAHPS Agencies

6. HCAHPS4Less Stakeholders

7. MedCAHPS Opportunity

8. MedCAHPS Solution

9. MedCAHPS Website Demo

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1. Purpose of MedCAHPS The purpose of the MedCAHPS is to create a Web Presence to:

1. Sell patient-centered, social media-empowered survey systems by EC Wise.

2. Sell HCAHPS survey call center and direct mail service.

3. Upsell 6 Sigma and Lean Process consulting services for companies like GP Strategies and Press Ganey.

HCAHPS

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS (pronounced “H-caps”), is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Three broad goals have shaped HCAHPS. First, the survey is designed to produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers. Second, public reporting of the survey results creates new incentives for hospitals to improve quality of care. Third, public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.

Since 2007 most hospitals have been required to submit HCAHPS results in order to receive full Medicare payment. Starting this year, HCAHPS will play an even larger role in reimbursement. The Patient Protection and Affordable Care Act establishes a Value-Based Purchasing (VBP) plan beginning in FY2013 (based on hospitals’ performance in 2012 on measures that are part of the hospital quality reporting program). This will transition providers from HCAHPS pay-for-reporting to HCAHPS pay-for-performance.

CAHPS

Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. CAHPS originally stood for the Consumer Assessment of Health Plans Study, but as the products have evolved beyond health plans, the name has evolved as well to capture the full range of surveys. The acronym "CAHPS" is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

All CAHPS surveys are in the public domain, which means that anyone can download and use these surveys to assess experiences with care. Users of CAHPS survey results include patients and consumers, quality monitors and regulators, provider organizations, health plans, community collaboratives, and public and private purchasers of health care. These individuals and organizations use the survey results to inform their decisions and to improve the quality of health care services.

The CAHPS program is funded and overseen by the U.S. Agency for Healthcare Research and Quality (AHRQ), which works closely with a consortium of public and private research organizations. AHRQ and its grantees and contractors develop and maintain the CAHPS surveys; they do not administer any of the surveys to health care consumers.

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2. Target Audiences The following audience segments represent Mitotel’s understanding as the target for the MedCAHPS Online Solution. All aspects of this project will be aimed at these specific groups.

1 – HCAHPS Survey Consumers • Organizations

o Hospitals o Survey Vendors o Value-Adding Resellers o Patient Safety Organizations o Six Sigma and Lean Process Intervention Providers

• Individuals and Decision Makers by Position o CEOs o Executive Leaders o Executive VPs o Quality Improvement Professionals o Nursing Managers o Project Managers o Purchasing Managers o Person directly responsible for leading HCAHPS improvement efforts

• Characteristics o Gender: Male and Female o Average Age:

21-35 years: 00% 36-45 years: 00% 46-55 years: 00% 55 years and older: 00%

o Income: $40,000-$80,000: 00% $80,001-$120,000: 00% -$120,000 and above: 00%

o Education Non-Graduate: 00% Graduate: 00% Masters: 00% Ph.D: 00%

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3. Competition The following companies represent Mitotel’s understanding of the key competition for MedCAHPS that will be used for competitive positioning and messaging.

1 - HCAHPS Approved Survey Vendors The organizations listed below have met HCAHPS participation requirements and are approved to administer the HCAHPS Survey. Highlighted companies are analyzed in the next section.

1 Alexandria Marketing Research Group, Inc. 23 LSUS Institute for HS and Public Policy

2 Altarum Institute* 24 Management and Technology Consultants*

3 Arbor Associates, Inc. 25 Minnesota Rural Health Cooperative

4 Avatar International LLC 26 NRC+Picker

5 Beacon Technologies, Ltd. 27 OutSource Services, Inc.*

6 CAMC Institute 28 Press Ganey Associates

7 Center for the Study of Services 29 Professional Research Consultants, Inc.

8 Communications for Research, Inc. 30 Quality Data Management, Inc.

9 Conifer Patient Communications, Inc* 31 Regenstrief Institute Inc.

10 CRG Medical InfoTool 32 Research & Marketing Strategies, Inc.

11 CTQ Solutions, LLC 33 Rural Comprehensive Care Network

12 Data Recognition Corporation 34 Rural Wisconsin Health Cooperative

13 DataStat, Inc * 35 Simple Precision, Inc. (formerly Data Based I i ht I )14 Field Research Corporation 36 Sterling Research Group*

15 Fields Research, Inc. 37 Strategic Health, Inc.

16 Gallup 38 Synovate*

17 Gilmore Research Group 39 The Dallas Marketing Group Inc.

18 Health Management & Informatics Group * 40 The Dieringer Research Group, Inc.

19 HealthStream Research 42 The Jackson Group

20 Informed Decisions, Inc.* 42 TNS*

21 J. D. Power and Associates 43 WestGroup Research

22 JL Morgan & Associates, Inc.

Organizations denoted with an asterisk (*) are conditionally approved to administer the HCAHPS Survey, pending acceptance of their Quality Assurance Plan and their participation in a Dry Run and/or successful submission of one quarter of hospital HCAHPS data to the data warehouse via My QualityNet.

Source: http://www.hcahpsonline.org/app_vendor.aspx

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2 – Other HCAHPS Value-Adding Providers The organizations listed below are value-adding HCAHPS participants. Highlighted companies are analyzed in the next section.

1 ActiveStrategy. 22 HIPOE

2 Amcom Software 23 LeaderPoint Consulting

3 AHA Solutions 24 Lean Human Capital

4 Atlantic Heath Solutions 25 Medelia

5 Baptist Leadership Group 26 NAPH

6 Baird Group 27 Phytel

7 Best Upon Request 28 Planetree

8 Beryl Institute 29 Siemens

9 CHANET 30 Sunnyside

106 CipherHealth 31 Skill Clinics

11 Compirion 32 Skylight Healthcare Systems

12 Crothall 33 Sodexo

13 Drive Ideas 34 SoranoHealth

14 Empath 35 StruderGroup

15 Enahanced 36 TVR

16 FaithSearch Partners, Inc. 37 The Beryl Institute

17 GetWell Network. 38 The CAHPS

18 GiveMore 39 The LeapFrogGroup

19 HCAHPS Consulting 40 Versus

20 HealthcareSource 41 Vocollect

21 Healthcare Team Training 42 Xantos

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3 – Competitors

Press Ganey – www.pressganey.com

• Tagline: Outcomes Driven. Performance Strong. • HCAHPS Solution Score: 10/10 • HCAHPS on Home Page: Barely • HCAHPS Solution(s)

o Value-Based Purchasing Optimizer o Value-Based Purchasing Calculator o Patient Experience Optimizer o PatientFlow Optimizer o PatientFlow Calculator o Focus Group Optimizer o Goal & Barrier Optimizer o Opportunity Assessment Optimizer o Employee Partner Optimizer o Secret Shopper Optimizer

• Social Media o • Blog: Press Ganey Improving Health Care Blog

http://pressganey.com/improvingHealthCare/improvingHCBlog.aspx o • Facebook: Press Ganey Associates, Inc.

http://www.facebook.com/pressganey 285 Like This

o • Twitter: Press Ganey http://fr.twitter.com/PressGaney

o YouTube Channel o RSS Feeds

http://pressganey.com/rss.aspx 7 Feeds

• Advertising: o Press Releases o Google Ads

• Search Engine: o 10th on 1st Page of Google Search

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Press Ganey – www.pressganey.com

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ActiveStrategy – www.activestrategy.com

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Amcom Software – www.amcomsoftware.com

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AHA Solutions – www.aha-solutions.org

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Atlantic Health Solutions – www.myatlantichealthsolutions.com

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Avatar International – www.hcahps.net

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Baird Group – www.baird-group.com

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Beryl Health – www.berylhealth.com

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Beryl Insitute – www.berylinstitute.com

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Baptist Leadership Group – www.baptistleadershipinstitute.com

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Best Upon Request – www.bestuponrequest.com

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Center for the Study of Services – www.cssresearch.org

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Chanet – www.chanet.org

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CipherHealth – www.cipherhealth.com

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Compirion Hospital Solutions – www.compirion.com

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Conifer Patient Communications, Inc. – www.coniferhealth.com

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Crothall– www.crothall.com

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CTQ Solutions, LLC – www.ctqsolutions.com

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Drive Ideas – www.driveideas.com

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Emmi Solutions – www.emmisolutions.com

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Enhanced Hospital Systems – www.enhancedhospitalsystems.com

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Fields Research, Inc. – www.fieldsresearch.com

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GetWell Network – www.getwellnetwork.com

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GiveMore – www.givemore.com

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Greystone Healthcare Management – www.greystonehcm.com

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Healthcare Source – www.healthcaresource.com

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Healthcare Team Training – www.healthcareteamtraining.com

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HealthStream – www.healthstream.com

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Home Health Care – www.homehealthcahps.org

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RTI International – www.rti.org

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Hospitals in Pursuit of Excellence – www.hpoe.org

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IncentiveOne – www.incentiveone.com

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Intelligent InSites – www.intelligentinsites.com

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J. D. Power and Associates – www.jdpower.com

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J.L. Morgan & Associates, Inc. – www.jlmorganandassociates.com

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Lean Human Capital – www.leanhumancapital.com

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Medelia – www.medelia.com

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NAPH – www.naph.com

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NCR Picker – www.nrcpicker.com

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OutSource Services, Inc. – www.outsourcenc.com

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Phytel – www.phytel.com

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Planetree – www.planetree.corg

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PRC – www.prconline.com

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ResDAC. – www.resdac.org

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Research & Marketing Strategies, Inc. – www.rmsresults.com

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Siemens Enterprise Communications – www.siemens-enterprise.com

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Enterasys – www.enterasys.com

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SironaHealth – www.sironahealth.com

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Skill Clinics – www.skillclinics.com

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Skylight Healthcare Systems – www.skylight.com

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Sodexo – www.sodexousa.com

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Sterling Research Group – www.sterlingresearchgroup.com

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Studer Group – www.studergroup.com

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Sunnyside– www.sunnysidecustomerservice.com

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The CAHPS – www.thecahps.com

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The Patient Safety Group – www.patientsafetygroup.org

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TVR Communications – http://tvrc.com

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Learn360 Health – www.learn360health.com

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The Jackson Group – www.thejacksongroup.com

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The Mesh – http://themesh.tv/cahps-cast/?currentPage=9

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The Mesh – www.Jginteractive.com

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Drive Leadership – www.driveleadership.com

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The Jackson Group Virtual Environment – www.thejacksongroup.com/tradeshow

http://www.sunrise-ax.com/

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Volcollect – www.vocollect.com

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Versus – www.versustech.com

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Xanitos – www.xanitos.com

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Key Competitive Breakdown

HCAHPS Power Rating

HCAHPS Market Share

HCAHPS Solutions

Value-Adding Products

Years in HCAHPS

ActiveStrategy 10 YES YES 12

AHA Solutions 5 NO YES NA

Atlantic Heath Solutions 10 YES YES 10

Avatar 8 YES YES 31

Baptist Leadership Group 7 YES YES NA

Best Upon Request 10 NO YES NA

Cipher Health 7 YES YES 3

CSS 1 NO NO NO

Conifer 6 NO YES 3

CTQ Solutions 5

Fields Research 7

Gallup 7

GetWell Network 7

GiveMore 7

Healthcare Team Training 8 YES

HealthStream Research 8 YES

J. D. Power & Associates 7

JL Morgan & Associates 7 YES

NRC+Picker 8 YES YES

OutSource Services 5

Press Ganey 10 80% YES YES

RMS 5

Skill Clinics 7 YES

Sodexo 7

SironaHealth 10 YES

StruderGroup 7 YES

The Beryl Institute 10

The CAHPS 8

The Jackson Group 7 YES

Xantos 7

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Search Engine Breakdown - Google

HCAHPS HCAHPS Training

HCAHPS Measures

HCAHPS & Value Based

Purchasing

HCAHPS Pay For

Performance

ActiveStrategy

AHA Solutions

Atlantic Heath Solutions

Avatar 11th

Baptist Leadership Group 5th 5th

Best Upon Request

Cipher Health #8 PPC

CSS

Conifer

CTQ Solutions

Fields Research

Gallup

GetWell Network

GiveMore #6 PPC #6 PPC #4 PPC

Healthcare Team Training

HealthStream Research #1 PPC #4 PPC #1 PPC #1 PPC 8th #2 PPC

J. D. Power & Associates

JL Morgan & Associates

NRC+Picker #4 PPC #5 PPC #5 PPC #3 PPC

OutSource Services

Press Ganey 10th

RMS

Skill Clinics #3 PPC #2 PPC #3 PPC

Sodexo

SironaHealth #2 PPC #3 PPC #3 PPC

StruderGroup 5th 1st & 2nd

The Beryl Institute

The CAHPS

The Jackson Group #7 PPC

Xantos #5 PPC #1 PPC #2 PPC #2 PPC #1 PPC

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Marketing Breakdown

Press Releases Action Page(s) Online Email Collateral

ActiveStrategy YES YES

AHA Solutions

Atlantic Heath Solutions YES YES

Avatar

Baptist Leadership Group YES

Best Upon Request

Cipher Health YES

CSS NO NO NO NO NO

Conifer YES

CTQ Solutions

Fields Research

Gallup

GetWell Network

GiveMore YES

Healthcare Team Training YES

HealthStream Research YES YES

J. D. Power & Associates YES

JL Morgan & Associates

NRC+Picker YES

OutSource Services

Press Ganey YES YES YES YES

RMS

Skill Clinics YES YES

Sodexo YES

SironaHealth YES YES

StruderGroup YES

The Beryl Institute YES

The CAHPS

The Jackson Group YES YES

Xantos YES

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Social Media Breakdown

Facebook Twitter YouTube LinkedIn Blog

ActiveStrategy YES YES YES

AHA Solutions ? ?

Atlantic Heath Solutions YES YES YES YES

Avatar YES YES YES Google

Baptist Leadership Group

Best Upon Request YES YES YES

Cipher Health YES

CSS

Conifer

CTQ Solutions

Fields Research

Gallup

GetWell Network

GiveMore

Healthcare Team Training

HealthStream Research

J. D. Power & Associates

JL Morgan & Associates YES YES YES

NRC+Picker YES YES YES YES YES

OutSource Services

Press Ganey YES YES YES YES

RMS YES YES

Skill Clinics YES YES

Sodexo

SironaHealth YES YES YES YES

StruderGroup YES

The Beryl Institute YES YES YES YES

The CAHPS

The Jackson Group YES YES YES

Xantos

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4. HCAHPS Agencies In 2002, the Centers for Medicare and Medicaid Services (CMS) asked the Agency for Healthcare Research and Quality (AHRQ) to develop an instrument to measure patient perceptions of care. This measurement would be used to publicly report hospital performance (quality of care as perceived by patients). The instrument to measure patient perceptions of care is HCAHPS or Hospital Consumer Assessment of Healthcare Providers and Systems.

The goal of this public reporting instrument, as stated by CMS, is to provide consumers with information that might be helpful in choosing a hospital. CMS has also stated that it should complement rather than compete with quality improvement instruments already being used by hospitals.

HCAHPS On-Line

• HCAHPS On-Line is the official HCAHPS Web site. • www.hcahpsonline.org/home.aspx • www.hcahpsonline.org/executive_insight/default.aspx

Agency for Healthcare Research and Quality

• www.ahrq.gov

AHRQ – CAHPS

• www.cahps.ahrq.gov/default.asp

AHRQ – Patient Safety Organization

• www.pso.ahrq.gov • www.pso.ahrq.gov/listing/alphalist5.htm#P0028

Hospital Compare

• www.hospitalcompare.hhs.gov

The Patient Safety Organization Privacy Protection Center

• https://www.psoppc.org/web/patientsafety

Center for Medicare & Medicaid Services

• www.cms.gov • www.cms.gov/HospitalQualityInits/30_HospitalHCAHPS.asp • www.cms.gov/HospitalQualityInits/downloads/HCAHPSCostsBenefits200512.pdf

QualityNet

• www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1140537251096

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

• www.cahps.ahrq.gov

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HCAHPS On-Line – www.hcahpsonline.org

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CAHPS On-Line – www.cahps.ahrq.gov

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5. MedCAHPS Stakeholders The MedCAHPS Online Solution is financially supported by a group of power players including CRGMedical, PSO Services Group, RWD and InfoTool.

CRGMedical – www.crgmedical.com

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PSO Services Group – www.psoservices.net

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InfoTool – www.infotool-online.com

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RWD - A Division of GP Strategies – www.rwd.com

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GP Strategies – www.gpstrategies.com

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6. EC Wise Opportunity

News Articles

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7. MedCAHPS Opportunity

News Articles The following news articles help describe the HCAHPS opportunity.

Healthcare IT News Healthcare technology: A competitive advantage in improving the patient experience February 01, 2012

With Meaningful Use requirements, connecting to Health Information Exchanges, coordinating data flow in Accountable Care Organizations, updating devices to ICD-10 codes and general interoperability projects, there is a tremendous amount of work going on in Health IT. With very significant deadlines to accomplish these vital initiatives, it would be easy for IT managers to develop tunnel vision and become project managers, checking off one task and moving on to the next.

Each of these projects to modernize the health system has tremendous potential to improve patient care, which, in turn, will likely improve patients’ perceptions of the care they receive because the care will be higher quality and better coordinated among providers. Patients, in turn, will be (everyone hopes) happier “customers.”

Over the past year, I’ve had the opportunity to get to know Jason Wolf and the interesting work he does as executive director of The Beryl Institute, which will host its annual Patient Experience Conference April 25-27 in Fort Worth, Texas.

Jason is a passionate advocate for improving the “patient experience” in healthcare, and he travels the country visiting different hospitals to see successful initiatives firsthand, and shares his findings with the Institute’s member organizations.

With so much of healthcare’s focus on changes on the IT front, I thought it would be good to ask Jason what he thinks about the technology changes and how they influence the patient experience.

Q. What exactly do hospitals mean when they talk about the “patient experience?”

Wolf: At The Beryl Institute, our commitment is to be the global community of practice and the premier thought leader on improving the patient experience. In beginning this journey we discovered that many were focused on two critical healthcare actions – patient centeredness and service excellence.

The reality of these two paths is that they have both made positive contributions to the care setting, but they only represented segments of the larger perspective and effort needed to drive an unparalleled experience for patients and their families. Patient experience encompasses the best of these actions, the important nature of quality and patient safety, and the recognition that experience starts well before a clinical encounter and continues well after the patient leaves the care setting.

To create a more standard perspective on this key component of healthcare success, we brought together healthcare leaders from across the U.S. to contribute to framing a definition for the patient experience. The result, a definition the Institute suggests healthcare organizations either adopt or adapt:

“We define the patient experience as the sum of all interactions, shaped by an organization’s culture that influence patient perceptions across the continuum of care.”

The key elements of this definition: that patient experience happens at every interaction, it is grounded in the culture of an organization, it is represented in the perceptions of the patient and their family, and it happens across the entire care curriculum. This also has significant implications for healthcare technology as well.

Q. With increasing emphasis on Electronic Health Records, Meaningful Use, Health Information Exchanges and Accountable Care Organizations, are you worried that the end goal of improving patient care may be lost during the process?

Wolf: I believe that technology and other organizational initiatives, especially related to current healthcare policies, are not an impediment to better patient care or overall experience. I see these as potential tools

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to support an increased patient experience effort if we are willing to recognize their important role in creating a greater focus on the patient in the care equation.

I have seen some use policy as an excuse for the inability to act on patient experience, but in fact, better record keeping, more efficient systems, expanded access and overall coordinated effort should all be positive contributing factors in our ability to improve patient experience overall. I believe a commitment comes down to leadership choice, clear organizational objectives and unwavering systems of accountability.

It is interesting to see that the introduction of the Healthcare Consumer Assessment of Healthcare Providers and Systems (HCAHPS) sparked an increase in focus on experience, but it was with the implementation of the Value-based Purchasing program, through which experience (as measured by HCAHPS) is now part of the overall reimbursement equation for healthcare organizations, that created real action. The bottom-line implications of patient experience became clear for most healthcare leaders and drove a new level of effort.

What is missing from this singular focus is that there are many more financial considerations and a significant case to be made for taking action on the patient experience. A focus on patient experience should not be considered only as a result of policy and technology requirements, but rather these should be used as the means by which to make more positive improvements overall.

Q: From your experience, how does technology influence patient care in the exam room? How can caregivers ensure that it is a positive factor?

Wolf: If we approach patient experience from the definition above, technology can definitely serve as a positive contributor to improving patient experience at multiple touch points across the continuum of care. Some standard technological improvements in the care setting that expedite reporting, create the ease of capturing data, or provide more efficient access to information, all create more opportunity for quality time at the bedside.

The implementation of interactive technologies that can be used in the engagement and education of patients directly in the care setting have also brought significant opportunities for impacting patient experience. Beyond the clinical setting, better scheduling technologies at the front end and the use of CRM tools to support post care follow-up can play a role across the patient journey.

The bottom line is focusing on what healthcare organizations are trying to achieve through a clear definition, understanding the implications for action and inaction based on policy, and recognizing the importance of visible leadership commitment and support is essential. These are the building blocks of any effective patient experience effort.

But it may very well be the bold choices of healthcare organizations to implement and apply technology in creative ways with an eye on the patient experience that provide the greatest competitive advantage and most positive impact on the patient experience overall.

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PR Newswire Higher Patient Ratings Indicate Hospitals Better Prepared for Value-based Purchasing -- In First Look at Impact of VBP, Latest Data from October 2011 Finds Average Hospital Rating Improved February 01, 2012

SOUTH BEND, Ind., Feb. 1, 2012 /PRNewswire/ -- According to Press Ganey, the average overall rating of hospitals by patients has improved following the start of the initial value-based purchasing (VBP) performance period in July 2011. This indicates that hospitals are better prepared to meet the new VBP criteria that affects their performance-based Medicare payments.

Based on proprietary patient discharge data through October 2011 - the most recent available - Press Ganey's findings supplement older, publicly available data to provide more current insight into the patients' view of hospital care. By comparison, the most recent publicly available data, released by the Centers for Medicare and Medicaid Services (CMS) on its Hospital Compare web site on Jan. 26, 2011, covers patients discharged April 1, 2010 through March 31, 2011. The most recent public data does not cover the VBP performance period, so it does not allow for analysis of how the initiation of VBP has impacted hospitals nationwide.

Press Ganey's proprietary database reflects the most current performance information from 44% of U.S. hospitals participating in CMS' Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

"Because we work with significantly more hospitals participating in HCAHPS than any other company, the more timely Press Ganey database foreshadows trends that will eventually show up in the publicly available HCAHPS data," said Deirdre Mylod, vice president, improvement services, Press Ganey. "Our analysis shows that hospitals prepared well for the start of the value-based purchasing performance period which began in July 2011. The sharp rise that we can see in our more recent data - which is not yet visible in the public data - is similar to the increase we saw in our database after CMS initiated a national consumer awareness campaign about the HCAHPS survey in May 2008."

The additional insight provided by more current data is especially valuable as hospitals refocus their improvement efforts to succeed under VBP. The Press Ganey proprietary database showed that in July 2011, hospitals had an average increase in the "overall rating of the hospital" of almost three-quarters of a point (0.7) compared to the previous month of June. CMS is scheduled to release its July 2011 HCAHPS data in July 2012 in the form of an annualized score. This public data set will not allow for analysis of seasonal trends or month-to-month comparisons.

According to Press Ganey's data for discharges from July through October 2011, since the VBP performance period began, the overall hospital performance score continued to improve and remained higher than the previous year. The average overall hospital rating in October 2011 was 0.9 percentage points higher than the average score for April 2010 through March 2011, the time period covered by the current public data set. CMS public data will include October 2011 discharges as part of its expected release in October 2012.

In addition, Press Ganey's analysis found that the average "likelihood to recommend" score for hospitals was 1.5 points higher in October 2011, compared to April 2010 through March 2011 results (the latest CMS data available). To understand the impact of this improvement, consider that in 2010 the American Hospital Association reported annual total hospital admissions of more than 36.9 million patients. The new level of performance seen in the Press Ganey data would translate into an annualized figure of nearly half a million more patients giving their hospital a rating of "definitely recommend" as compared to the year ending in March 2011.

The HCAHPS survey is a national, standardized, publicly reported survey of patients' perspectives of hospital care. The most recent HCAHPS data from CMS is available on the Hospital Compare web site at hospital.compare.hhs.gov and covers discharges through March 2011.

To receive future Press Ganey reports on HCAHPS data, email [email protected].

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EurekAlert Penn State team's QR code wins REACH Challenge February 02, 2012

"Real-Time Care Experience Feedback Using QR Codes," a Penn State project that allows hospital patients to inform hospital personnel of their experiences -- good or bad -- in real time, is the winner of the 2012 REACH Developer Challenge, sponsored by AcademyHealth and part of the Health 2.0 Developer Challenge.

"As a former health care provider, I have witnessed patients' confusion about why it was taking so long to see a doctor, and I have seen family members worried about their loved ones and unable to get information about them," said Deirdre McCaughey, professor of health policy and administration. "Our application of QR-code technology will enable hospitals to say to patients and their family members, 'We care about you, we are listening to you, and we are willing to talk to you about your concerns right now.'"

The winning team included McCaughey; Dominique LaRochelle, 2009 alumna of the master of health administration program; and Shantanu Dholakia, Ashley Kimmel, Tejal Raichura and Latoya Tatum, graduate students currently in the program. Aamer Ghaffer, an information-technology developer, assisted with the project's QR-code technology.

McCaughey said that the team envisions hospitals and waiting rooms with placards on their walls designed like stoplights that read, "How are we treating you today?" People can walk up to the placard, use the QR-code applications on their phones to scan the appropriate area -- green for good, red for bad -- and be directed to a response-specific web survey on which they can note their concerns and comments. Ideally, she said, hospitals would have a patient-experience response team on call 24/7 to attend to these concerns immediately. McCaughey noted that not only will the application benefit patients, but it also will benefit hospitals.

"It is becoming increasingly common for people who are having a negative experience to tweet about it as they are waiting or receiving care or to blog about the experience afterward," she said. "So now, not only are these patients disappointed with the care they are receiving, but others who did not have the experience can read these tweets and blogs and be influenced by them. In essence, health care organizations are developing reputations via social media that they have little control over."

McCaughey said that this is a growing concern since patients' opinions can directly affect hospitals' revenue streams.

"Under the Value-Based Purchasing Program instituted by the Centers for Medicare & Medicaid Services, Hospital Consumer Assessment of Healthcare Providers and Systems surveys are sent to former patients asking for a rating of the patients' experiences and the quality of the care they received," she said. "HCAHPS patient-experience ratings account for a portion of the points hospitals earn for patient care, with earned points directly related to the reimbursement that hospitals receive from the Centers for Medicare & Medicaid Services."

Integrating patient experience and organizational reputation is of paramount importance, noted LaRochelle, who guided the team's practical application.

"Health care providers have a brand to promote and protect," she said. "It's important to have a multi-faceted strategy to manage both promotion and protection; and that means managing to the communication forums used by patients and their families."

The team's QR-code application aims to ensure patients receive the best care possible while also helping hospitals receive the highest reimbursement possible from the Centers for Medicare & Medicaid Services. The group plans to continue working on the process to fully develop the protocol and currently is negotiating with select hospitals for beta-sites to test the application.

A proto-type test of the team's project, which beat out 17 other projects in the competition, will be showcased at the AcademyHealth National Health Policy Conference to be held in Washington, D.C., February 13-14, 2012. The group will receive travel support to attend the conference and will be presented withhttp://www.fiercehealthcare.com/ a $5,000 cash prize.

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Fierce Healthcare Hospitals ready for value-based purchasing with higher patient satisfaction February 2, 2012

Despite the dark cloud of reduced reimbursements, hospitals are prepared for value-based purchasing (VBP) with patients reporting higher satisfaction levels, according to Press Ganey.

Noting that CMS Hospital Compare public data does not cover the VBP performance period, Press Ganey looked at patient discharge data through October 2011--the most recent available--and found that patients' average "likelihood to recommend" score for hospitals was 1.5 points higher in October 2011, compared to April 2010 through March 2011.

In July 2011, hospitals saw an overall rating average increase of almost three-quarters of a point (0.7) compared to the previous month. Nearly half a million more patients would "definitely recommend" their hospital, compared to the previous year (ending in March 2011), according to Press Ganey, which used American Hospital Association admissions data for more than 36.9 million patients.

Since the VBP performance period began, the overall hospital performance score has continued to improve. The average overall hospital rating in October 2011 was 0.9 percentage points higher than the average score for April 2010 through March 2011, according to Press Ganey.

"Our analysis shows that hospitals prepared well for the start of the value-based purchasing performance period which began in July 2011," Deirdre Mylod, vice president, improvement services at Press Ganey, said in an announcement yesterday. "The sharp rise that we can see in our more recent data--which is not yet visible in the public data--is similar to the increase we saw in our database after CMS initiated a national consumer awareness campaign about the HCAHPS survey in May 2008."

Forty-four percent of U.S. hospitals participate in CMS' HCAHPS survey.

Starting in October, Medicare reimbursements to hospitals will be based on performance measures, according to rules from the Centers for Medicare & Medicaid Services issued last year. Patient satisfaction will determine 30 percent of the incentive payments, while improved clinical outcomes will decide 70 percent.

The measure is troubling, Martin Ciccocioppo, vice president of research for the Hospital & Healthsystem Association of Pennsylvania, told the (Scranton, Pa.) Times-Tribune in January. "There's no clear scientific link between (patient satisfaction) and the quality of care they received," he said.

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News Excerpts The following news excerpts help describe the critical nature of the HCAHPS opportunity.

Advance Web Where Is the Soap? Why Communication Is No. 1 in the Continuum of Care January 25, 2012

• Now that patient satisfaction scores have been tied to reimbursement, hospitals are scrambling to create an environment that is welcoming, safe and comfortable. They're spending money to beautify their rooms, update their systems with electronic medical records, and provide patient rooms with the latest and greatest technology, such as fancy flat screen televisions that also function as meal planners and patient education tools.

Association of American Medical Colleges Value-Based Purchasing Presents Challenges to Teaching Hospitals January 2012

• Starting October 2012, hospitals will be paid under a new Centers for Medicare and Medicaid Services (CMS) program that ties a percentage of their Medicare reimbursement to performance on a set of quality metrics, including patient satisfaction. Called a value-based purchasing (VBP) program, it is one of three new performance-based payment programs under the Affordable Care Act. The other two payment programs focus on performance related to readmissions and hospital-acquired conditions.

• The VBP program will combine a hospital’s score on a patient satisfaction survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), with the facility’s success on 12 process-of-care measures. Poor performance on these measures can mean a reduction in reimbursement—when providers and facilities are already fighting to retain their payments.

Hospital Impact Commit to patient experience in 2012 January 5th, 2012

• A significant shift is that the concept of patient experience was forever changed in 2011. The year started as "conceptual," meaning organizations were being measured on patient experience performance based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and results were reported compared to their peers.

• It made patient experience an issue of comparative perception--that is, how the market viewed an institution and how it compared to its peers. Some recognized the implications of this situation alone--that market choices were being influenced by scores and prevailing reputation. This idea--the return on service--will continue to have serious and growing implications on the overall operations of healthcare organizations.

• This conceptual focus faced a significant change halfway through 2011, with a hard turn to the "practical." This generated an almost frantic increase in activity and raised the profile of the patient experience to new levels.

• On July 1, value-based purchasing arrived. A real and measurable performance period began that would not simply compare healthcare organizations across markets, but also would impact the actual reimbursement dollars institutions would receive across a much broader spectrum. As one CNO said to me last July, "Spring training is over and the regular season is on!"

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Health Leaders Media Top 12 Healthcare Quality Concerns in 2012 January 4, 2012

• Patient experience scores hinge on "always" responses. The value-based purchasing sweepstakes have begun, with the first performance period for clinical process of care and HCAHPS (Hospital Consumer Assessment of Healthcare

• Providers and Systems) questions scheduled to end March 31. Payment adjustments will begin for patients discharged as of Oct. 1, and the winners and losers will then be revealed.

• What makes many hospitals and clinical nurse managers most nervous, however, is that the patients responding to these surveys must reply "Always," in order for the hospital to get credit for high quality patient experiences.

Becker’s Orthopedic and Spine Hospital Value-Based Purchasing Program: An Introduction for Anesthesiologists January 04, 2012

• Medicare's Value-Based Purchasing (VBP) program for hospitals, mandated by the Affordable Care Act, took off upon the release of final regulations on April 29, 2011. VBP marks the start of true pay-for-performance, as opposed to pay-for-reporting, at the hospital level. The intent is to pay for better value, patient outcomes and innovations, and not simply to reward volume of services.

• As we enter 2012, we are halfway through the first performance period. Anesthesiologists should begin analyzing and planning how they might partner with their hospitals in achieving the scores necessary to earn VBP incentives.

• The hospital scores are based on Clinical Process of Care measures (70%) and on Patient Experience of Care (30%) as measured by completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Hospitals receive points for achievement and improvement for each measure in the two domains, with the greater set of points counting toward the domain total.

• There are 12 measures in the Clinical Process of Care domain, and 8 HCAHPS "dimensions" in the Patient Experience domain. There are several measures for which anesthesiologists can take or share responsibility, as shown in italics in the lists below. Anesthesiologists, CRNAs and AAs can also contribute to the hospital's performance on virtually all the dimensions of Patient Experience.

Insurance News Net A new customer service partnership for hospitals and physicians December 23, 2011

• The government's value-based purchasing model includes weighted domains to calculate hospital payment levels. In this model, 70 percent of payment is based on clinical quality scores, while the remaining 30 percent is based on results of a standardized survey instrument, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which collects and compares patients' perceptions of their hospital care (www.hcahps.org).

• What's more, astute clinical and financial leaders recognize that the importance of customer service goes beyond HCAHPS. One reason to embrace better customer service is that it may help prevent litigation, because people are less likely to sue for poor clinical outcomes if they perceive their caregivers truly care about them. There are also financial advantages of having a brand that attracts business because of its reputation for excellence- in other words, consumers often perceive customer service as quality.

• Working to solve root causes of poor customer service in a hospital is more complicated than simply developing a strategy to improve HCAHPS scores. If physicians do not share in this effort, the hospital runs potential political risks, such as the alienation of some medical staff members who may still see themselves as the primary customers. Such risks underscore the importance of cultivating the partnership with physicians in working to improve customer service. There are also financial ramifications, such as the potential investment in coaching and training managers to appropriately address behavior that affects customer satisfaction. And if the root cause of poor patient satisfaction

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is poor employee satisfaction, a brand new root-cause analysis will be needed to determine the causes and possible solutions for that.

• In short, the risks of not addressing root causes of patients' poor perceptions of service are substantial. These include lower revenues (because of low HCAHPS scores or loss of customers), a compromised reputation, suboptimal quality, and a failure to achieve the organization's mission. Making patient satisfaction a top organizational priority is necessary to mitigate these risks.

Becker’s Hospital Review Report: Investment in Patient Experience Impacts Finances, Marketing and Clinical Measures November 30, 2011

• A new white paper from The Beryl Institute contends improving patient experience has financial implications that reach beyond reimbursement dollars, performance pay and compensation tied to outcomes. The paper examines the return on providing excellent service from financial, marketing and clinical perspectives and offers research and justification for investing in patient experience efforts to achieve valuable returns.

• From the financial perspective, satisfied patients lead to higher profitability. In a 2008 J.D. Power study, it was discovered that hospitals scoring in the top quartile in satisfaction had over two times the margin of those at the bottom. These findings were supported by the 2008 Press Ganey paper,

• From the marketing perspective, look no further than the power of word of mouth. In her 2004 article, Jacqueline Zimowski shared that a satisfied patient tells three other people about a positive experience. In contrast, a dissatisfied patient tells up to 25 others about a negative experience.

• The issue worsens, as for every patient that complains, there are 20 other dissatisfied patients that do not. And of those dissatisfied patients that don’t complain, only 1 in 10 will return. When you run the numbers, for every complaint you hear, you could be losing a potential 18 patients. In essence by not focusing on experience, hospitals and other healthcare providers are potentially driving patients away.

• From the clinical perspective, healthcare providers must be clear to recognize that experience and quality are critically interwoven aspects of overall care. Patient Experience is about ensuring patients leave better than when they arrived (as often as possible). This was exemplified in a powerful way in the 2011 study by Boulding et al. They examined quality factors and satisfaction factors in relationship to readmission rates within 30 days of discharge. The finding was surprising. The HCAHPS scores, i.e. experience outcomes, were reliable and even more predictable indicators of readmissions than quality indicators.

Dot Med News Direct link found between public reporting and hospital performance improvements November 21, 2011

• Mandates for public reporting of quality care data are having a positive impact on quality performance improvements, according to the 2011 Pulse Report from Press Ganey Associates, Inc., a patient health care survey provider.

• "It's common sense," said Nell Wood-Buhlman, vice president, clinical products at Press Ganey. "Whenever anything is subject to scrutiny, evaluation and transparency, there tends to be an interest among those being measured to make sure they are cast in a positive light."

• CMS predicts the U.S. will spend $4.6 trillion on health care annually by 2020, representing 20 percent of gross domestic product - an unsustainable course. Regardless of this spending, Press Ganey's report stated that the quality of U.S. health care requires further improvements.

• With steadily increasing data reporting requirements, over the past six years the Hospital Consumer Assessment of Healthcare Providers and Systems survey scores have been steadily rising. HCAHPS makes up 30 percent of the total hospital inpatient VBP score. Hospitals must perform above the 50th percentile on all HCAHPS measures to receive full points for consistency.

• "As hospitals are subject to more and more reporting mandates and pay-for-performance mandates, they are paying close attention to a variety of performance aspects," said Wood-Buhlman. "Everything is moving in the direction we want to see it moving in."

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SMS Healthcare Reimbursements Now Tied to Patient Satisfaction November 21st, 2011

• Hospitals are taking note of patient satisfaction with reimbursements on the line. Starting next year, Medicare will examine patient satisfaction scores when reimbursing hospitals, and better performing hospitals will win out on the incentive.

• That leaves some hospitals concerned that their reimbursements will crumble under the new patient satisfaction considerations, reports Kaiser Health News and The New York Times. Hospitals that either can’t afford luxury amenities or simply hospitals who already receive low scores might not appreciate the somewhat subjective ratings.

• Effective October 2012, the Centers for Medicare and Medicaid Services will withhold 1 percent of regular reimbursements based on performance, an estimated $850 million, according to The Wall Street Journal. Patient experience makes up for 30 percent of the total bonus payments.

The Wall Street Journal Increased Patient Satisfaction Scores Influence Reimbursements November 16th, 2011

• Hospitals with high performance scores in patient care are more profitable, according to a new Press Ganey report. The top 25 percent of U.S. hospitals with the highest scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question about performance were, on average, the most profitable and had the highest clinical scores, suggesting that patient experience, coupled with clinical outcomes, can mean financial profitability for the institution.

• With the Centers for Medicare & Medicaid Services’ (CMS) first national pay-for-performance program, hospitals now link quality with reimbursements. Through the Hospital Inpatient Value-based Purchasing Program (VBP), starting on July 1 hospitals began reporting clinical and patient experience measures from which CMS calculated VBP scores. HCAHPS makes up 30 percent of the total hospital inpatient VBP score. Effective Oct. 1, 2012, those scores will translate into reimbursement changes, according to the report. And by 2013, hospitals will face penalties for negative clinical outcomes, such as high readmission rates and hospital acquired infections.

Wall Street Journal Informed Patient: Tying Hospital Payments to Patient Satisfaction November 8, 2011

• Hospitals are scrambling to improve customer service in advance of a change tying Medicare payments to higher scores on patient-satisfaction surveys, today’s Informed Patient column reports.

• But improving patient satisfaction means engaging hospital staff in the effort — and changing hospital cultures that haven’t traditionally focused on the patient as a customer. Hospitals are hiring consultants and service coaches to help, training employees to be more responsive, bringing in executives with experience in the hospitality industry, and even tying employee compensation to a hospital’s performance on the satisfaction surveys, known as HCAHPS.

• Starting next fall, hospitals will lose 1% of their so-called DRG (for Diagnosis-related group) payments, under which Medicare pays hospitals a flat per-case rate for inpatient care.

• But under a provision in the new health law, they will be able to earn back the 1% — and in some cases more than that — based on a performance score made up of clinical quality measures (70%) and patient experience of care (30%). Scores will be based on the higher of achievement of national median performance or improvement from the hospital’s past performance in that measure.

• A number of hospitals have protested the 30% given over to patient satisfaction scores, telling Medicare that it puts hospitals that care for sicker patients at a disadvantage.

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Becker’s Hospital Review The Perfect 10: Hospital Officials Scramble to Ace Patient Satisfaction Scores November 08, 2011

• Hospitals across the country are trying to boost the patient experience and maintain federal reimbursement under value-based purchasing, but a lack of control over satisfaction scores is leaving many hospital executives concerned, according to a New York Times report.

• The VBP program is based on measures used in the Hospital Inpatient Quality Reporting program, including patient experience measures as indicated by CMS' HCAHPS survey. Information collected from hospitals from July 1, 2009-March 31, 2010, serves as the baseline. Hospitals that improve outcomes or achieve certain performance standards, compared to their baseline performance, will receive incentive payments for discharges occurring on or after that time.

• Patient experience ratings will determine 30 percent of the total bonus payments. The HCAHPS survey asks patients a variety of questions, including one in which they must rank their hospital stay on a scale from 1-10. Medicare will only credit hospitals that receive a nine or 10.

Wall Street Journal A Financial Incentive for Better Bedside Manner NOVEMBER 8, 2011

• Starting next fall, the federal Medicare program will withhold 1% of a vital payment—totaling an estimated $850 million, with the percentage doubling to 2% in 2017—as part of a program in last year's U.S. health-care overhaul designed to force hospitals to improve the quality of care and trim costs. Hospitals can make up the cuts and even earn additional payments by performing well on two measures: quality standards for medical care, and patient-satisfaction surveys known as the Hospital Consumer Assessment of Healthcare Providers and Services, or HCAHPS.

• About a third of the incentive payments are tied to patient satisfaction, so hospitals are putting doctors, nurses and other employees through customer-service training, hiring patient-experience consultants and creating dedicated departments, and designating staff ombudsmen to deal with complaints.

• The 27-question surveys, sent by hospitals to a random sample of adult patients at home after a hospital stay, ask patients to rate hospitals on measures including cleanliness, quiet, and whether doctors and nurses listened to patient concerns and explained medications. They also ask patients to rate their overall satisfaction and whether they would recommend the hospital to friends and family. This is driving hospitals to offer extra services such as massage, reflexology, aromatherapy, and musical performances.

• More than a quarter of the approximately 36 million patients admitted to all U.S. hospitals received a survey and more than 7% completed it in 2009. Since 2008, results have been posted on Medicare's Hospital Compare website, along with quality-of-care ratings. But until now there has been no financial incentive to improve patient-satisfaction scores—and as the current national results show, there is plenty of room for improvement.

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9. MedCAHPS Website Demo

MedCAHPS Website Demo

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