APRIL 21 2015

HCAHPS Patient Experience Surveys:

Current and Future Requirements

Agenda

HCAHPS OverviewSurvey updatesCommunicating with patients about the

HCAHPS SurveyNew STAR rating program

Consumer Assessment of Healthcare Providers and Systems

Produce comparable data for public reporting Create incentives to improve Enhance public accountability and transparency

HCAHPS Overview

Impacted Facilities

General Acute Care Hospitals paid under the IPPS Critical Access Hospitals participation required under MBQIP 2015

Voluntary Implementation October 2006 dischargesMandatory Implementation July 2007 dischargesPay for Performance July 2011 discharges

Patient Population Adult medical, surgical, or obstetrical patients with an overnight stay

Survey Length 32 questions

Survey TimingContinuous data collection which must be initiated within 6 weeks of discharge

Distribution Options Mail and telephone

HCAHPS Survey Revision

Mail survey currently available in English, Spanish, Chinese, Russian, Vietnamese, and Portuguese

Telephone survey currently available in English and Spanish

New: Response option for “Portuguese” is being added to question 32

Hospital VBP Time Periods:

Performance Period FY 2016: January 2014 – December 2014 Must have 100+ completed HCAHPS Surveys in

Performance Period to be included in Hospital VBP Four Hospital VBP Domains for FY 2016:

Clinical Process of Care (8 measures) Patient Experience of Care (HCAHPS; 8 measures) Outcomes (Mortality, safety, HAI; 7 measures) Efficiency (Medicare spending per beneficiary; 1 measure)

Patient Experience Domain comprises 25% of Hospital VBP TPS in FY 2016

Clinical Process: 10%; Outcomes: 40%; Efficiency: 25%

Hospital VBP Time Periods:

Calendar Year 2015 will be thePerformance Period for the FY 2017 Hospital VBP

program–Coupled with the Baseline Period of CY 2013

Baseline Period for the FY 2019 program–Coupled with the Performance Period of CY

2017Information on calculating HCAHPS Hospital VBP

Domain Score

http://www.hcahpsonline.org/Files/Hospital%20VBP%20Domain%20Score%20Calculation%20Step-by-Step%20Guide_V2.pdf

MBQIP 2015-2016

HCAHPS reporting requirement for MBQIP will be attached to FLEX and SHIP funding.

Beginning in September 2015

Data Submission Deadlines

Updates to HCAHPS

Quality Assurance Guidelines (QAG) V10.0

HCAHPS Communication Guidelines

Hospitals SHOULD NOT• Ask patients for a certain score• Indicate that their goal is to receive a certain score• Show the HCAHPS survey or cover letter to the patient prior to

survey administration• Wear a button which says “10” or “Always”

Hospitals SHOULD• Encourage response to the survey“It is permissible to notify the patient while in the hospital or at discharge that they may receive a survey after discharge.”

• Improve the patient experience• Distribute the communication guidelines

HCAHPS Communication Guidelines

New: Hospitals/Survey vendors or their agents are not allowed to display signage denoting “Always” or “10”

New: Hospitals are not allowed to emphasize the HCAHPS questions or response options in posters, white boards, rounding questions, in room television, or other media accessible to patients:

Examples of inappropriate messages include -

“We expect to be the best hospital possible.”“Our goal is to always address your needs.”“Let us know if we are not listening carefully to you.”“We treat our patients with courtesy and respect.”“In order to provide the best possible care, please tell

us how we can always…”“Our doctors and nurses always listen carefully to

you.”“We want to always explain things to you in a way you

can understand.”“We want you to recommend us to family and

friends.”

Examples of statements that comply with HCAHPS protocols include -

“We are looking for ways to improve your stay. Please share your comments with us.”

“What can we do to improve your care?”

“We want to hear from you, please share your experience with us.”

“Please let us know if you have any questions about your treatment plan.”

“Let us know if your room is not comfortable.”

New for HCAHPS – STAR ratings

As part of a new initiative to add five-star quality ratings to its Compare Web sites, the Centers for Medicare & Medicaid Services (CMS) will add HCAHPS Star Ratings to the Hospital Compare Web site

Star Ratings page on the HCAHPS Web site at http://www.hcahpsonline.org.

Why Star Ratings for Hospital Compare?

Consumers are the primary audience for Hospital Compare, along with other important stakeholders

The National Quality Strategy envisions effective public reporting as a key driver for improving the health care system as a whole: Consumers consult ratings Consumers choose the care that is best for them and

their families Providers are incentivized to improve quality to retain

existing patients and to attract new ones

Principles for Star Ratings

Report what is most important to patients in a way they can understand

Leverage knowledge and lessons learned from existing sites

Not all measures are appropriate for Star Ratings

Transparency of methodology and display with stakeholders

Supplement information already on Hospital Compare

Coordinate across all Compare Web site

Overview of HCAHPS Star Ratings

CMS added Star Ratings for HCAHPS measures beginning with the April 2015 public reporting on Hospital Compare (Posted April 16 2015)

Patients discharged from July 2013 to June 2014

No previous HCAHPS information was removed from Hospital Compare when HCAHPS Star Ratings are added to the Web site

New for HCAHPS – STAR ratings

HCAHPS Composite Measures1. Communication with Nurses (Q1, Q2, Q3)2. Communication with Doctors (Q5, Q6, Q7)3. Responsiveness of Hospital Staff (Q4, Q11)4. Pain Management (Q13, Q14)5. Communication about Medicines (Q16, Q17)6. Discharge Information (Q19, Q20)7. Care Transition (Q23, Q24, Q25)HCAHPS Individual Items8. Cleanliness of Hospital Environment (Q8)9. Quietness of Hospital Environment (Q9)HCAHPS Global Items10. Overall Hospital Rating (Q21)11. Recommend the Hospital (Q22

New for HCAHPS – STAR ratings

100 Completed Survey Minimum for HCAHPS Star RatingsIn order to receive HCAHPS Star Ratings,

hospitals must have at least 100 completed HCAHPS Surveys over a given four-quarter period. In addition, hospitals must be eligible for public reporting of HCAHPS measures. Hospitals with fewer than 100 completed HCAHPS Surveys will not receive Star Ratings; however, their HCAHPS measure scores will be publicly reported on Hospital Compare.

Process of Creating HCAHPS Star Ratings

Step 1Construction and Adjustment of HCAHPS

Linear Mean Scores All survey responses are used in the construction of

HCAHPS Star Ratings Survey responses are converted into linear mean

scores The linear mean score for an HCAHPS measure

summarizes all the responses to the survey items included in that measure

HCAHPS Star Ratings Linear Mean Scores

HCAHPS Survey responses are converted to a 0-100 score as follows:

Never 0; Sometimes 33 1/3; Usually 66 2/3; Always 100

Strongly disagree 0; Disagree 33 1/3; Agree 66 2/3; Strongly agree 100

No 0; Yes 100

Rating 0 = 0; Rating 1 = 10; … Rating 10 = 100

Definitely no 0; Probably no 33 1/3; Probably yes 66 2/3; Definitely yes 100

HCAHPS scores are averaged to obtain linear means for each measure

Process of Creating HCAHPS Star Ratings

Step 2Conversion of Linear Mean Scores to HCAHPS

Star Ratings

A statistical clustering technique is applied to HCAHPS linear mean scores Clustering identifies star groups that maximize differences

between groups and minimize differences within groups There are no pre-determined quotas for the star categories Same method is used for many CMS Part C and Part D Star

Ratings

Converting Linear Mean Scores to HCAHPS Star Ratings

1, 2, 3, 4 or 5 whole stars are assigned to each HCAHPS measure

–No half-stars are assigned

Process of Creating HCAHPS Star Ratings

Step 3Calculation of the HCAHPS Summary Star

Rating

HCAHPS Summary Star Rating

The HCAHPS Summary Star Rating combines the Star Ratings of all the HCAHPS measuresThe HCAHPS Summary Star Rating is the average of

9 elements:– 7 Star Ratings from the HCAHPS composite measures Average of Cleanliness and Quietness stars Average of Overall Rating and Recommend stars

Normal rounding rules are applied to the HCAHPS Summary Star Rating average to assign 1, 2, 3, 4 or 5 whole stars–No half-stars are assigned

Example for Calculation of Summary Star Rating

HCAHPS Star Rating Cut Points for Patients Discharged Between July 1, 2013 to June 30, 2014

National Distribution of Star Ratings

Star Rating Number of Hospitals Percent of Hospitals

251

7%

1,205

34%

1,414

40%

582

16%

101

3%

Not Rated 1,102 N/A

Georgia’s Distribution of Star Ratings

Total # of Georgia hospitals rated: 100

Average Star rating:3.2

% hospitals With 5 Stars: 4%

% hospitals With 4 Stars: 30%

% hospitals With 3 Stars: 46%

% hospitals With 2 Stars: 18%

% hospitals With 1 Star: 2%

Questions

GHA Contact Information

KATHY MCGOWAN, VICE PRESIDENT OF QUALITY & SAFETYKMCGOWAN@GHA.ORG 770-249-4519JOYCE REID, VICE PRESIDENT OF COMMUNITY HEALTH CONNECTIONSJREID@GHA.ORG 770-249-4545LISA CARHUFF, QUALITY IMPROVEMENT/PATIENT SAFETY SPECIALISTLCARHUFF@GHA.ORG 770-249-4553