The HCAHPS and Competency ConnectionHealthStream, 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

To improve the quality of healthcare

by assessing and developing the people that deliver care.

VISIONHealthStream’s

Actionthroug

h Learnin

g

Insightthroug

hResear

ch

Measurement Learning

Improved Performan

ce

VBP Report Card

Learning Platform

Improvement Courseware

Call Center

HCAHPS Impact Report

Insights Online

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!

Differences in Survey Question Scales

Overall, how would you rate the care you received?

Very Good Good Fair Poor Very Poor

53% 22% 14% 9% 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 ResultsHow 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• Repealed January 19, 2011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

• Reimbursement FY2013: 1.00% of payments• Reimbursement FY2014: 1.25% of payments• Reimbursement FY2015: 1.50% of payments• Reimbursement FY2016: 1.75% of payments• Reimbursement FY2017+: 2.00% of

payments70% of reimbursement based on 15 clinical and outcome

measures

30% on HCAHPS survey results

MBQIPMedicare 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%

DateJul `07 - Jun `08

Oct `07 - Sep `08

Jan `08 - Dec `08

Apr `08 - Mar `09

Jul `08 - Jun `09

Oct `08 - Sep `09

Jan `09 - Dec `09

Apr `10 - 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 69% 69% 69% 70% 70% 70% 70% 71% 2%Quietness of Area Around Room at Night 56% 56% 56% 56% 57% 57% 57% 58% 2%

Discharge Information 80% 80% 80% 80% 81% 81% 81% 81% 1%

Overall Rating of Hospital 64% 64% 64% 65% 65% 66% 66% 67% 3%Willingness to Recommend Hospital 68% 68% 68% 68% 68% 68% 69% 69% 1%

HCAHPS Composite 68% 68% 68% 68% 69% 69% 69% 70% 2%

HCAHPS Overall Performance

Exploring the Impact of Competency on HCAHPS

Linking Employee and Physician Satisfaction and

Competencyto 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.

• 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

• Dependent Variable:• HCAHPS Overall Hospital Score

Summary of HCAHPS Predictors

Three variables significantly predicted HCAHPS scores:

Significant PredictorsStandardiz

ed 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

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. TaylorRegional Director(443) 744-0299

kylie.taylor@healthstream.com