HCAHPS: How Pharmacists can Impact Patient Experience

Meghan E. Tolan, PharmD, MBA Candidate

PGY2 Health System Pharmacy Administration Resident

The Johns Hopkins Hospital

Disclosure

• I have no relevant financial relationships or commercial interests to disclose for this presentation.

Objectives

• Summarize the purpose and goals of the HCAHPS survey

• Describe the relationship between HCAHPS performance and CMS reimbursement

• Identify how pharmacists can impact patient experience in the hospital setting

Pre-Assessment

Which of the following survey questions can pharmacists impact through direct patient care?

A. How often was your pain well controlled?

B. How often did hospital staff describe possible side effects in a way you could understand?

C. When I left the hospital, I clearly understood the purpose for taking each of my medications.

D. A, B and C

Customer Experience

The Institute for Healthcare Improvement Triple Aim

Available from: http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx. Accessed 2015 Sept 1.

HCAHPS Survey

• Hospital Consumer Assessment of Healthcare Providers and Systems

• Consists of 32 standardized questions

• Used to measure experience of adult inpatients with an overnight stay

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

Purpose of HCAHPS

• Drive to establish national standards for comparing patient perceptions of care

• Way to uniformly measure and publicly report patients’ perspectives on their inpatient care

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

Goals of the HCAHPS Survey

1. Produce comparable data on patients’ perspectives of care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers

2. Create incentives for hospitals to improve their quality of care

3. Enhance public accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

HCAHPS Survey Instrument

CMS Rules: Communicating with Patients about the HCAHPS Survey

• Hospitals can inform patients that they may receive a survey after discharge

• To prevent bias of survey results, hospitals CANNOT:– Post or hand out copies of the survey– Ask patients any HCAHPS questions– Encourage patients to answer questions in a particular way– Indicate that the hospital’s goal is for all patients to rate them

as a “10,” “Definitely yes,” or an “Always”– Imply anyone will be rewarded for positive feedback from

patients– Ask patients to explain why they did not rate a hospital with the

most favorable rating possible– Offer incentives of any kind for participation in the surveyCenters for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

HCAHPS Public Reporting

• Reported four times each year

• Lag time for CMS reporting

• CMS adjusts results to create “level playing field”– Adjustments made for mode and patient

mix

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

Reporting of HCAHPS Scores

• Hospital Compare– http://www.medicare.gov/hospitalcompare

Available from: http://www.medicare.gov/hospitalcompare/search.html. Accessed 2014 Oct 17.

Top-Box Response

Survey Question Scale Top-Box

During the hospital stay, how often was your pain well controlled?

Never, Sometimes, Usually, Always

Always

Using any number from 0 to 10, where 0 is the worst hospital possible, and 10 is the best hospital possible, what number would you use to rate this hospital?

0-10 9 or 10

When I left the hospital, I clearly understood the purpose for taking each of my medications.

Strongly Disagree, Disagree, Agree, Strongly Agree

Strongly Agree

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

HCAHPS Star Ratings

Image: http://datascience.berkeley.edu/wp-content/uploads/2014/02/Star-Rating.jpg

CMS Reimbursement Implications

• Inpatient Prospective Payment System (IPPS)

• Value Based Purchasing (VBP) in 49 states and Washington D.C.

• Quality Based Reimbursement (QBR) in Maryland

Value Based Purchasing

• CMS initiative• Established by The Patient Protection

and Affordable Care Act of 2010• Rewards hospitals with incentive

payments for quality of care• Applies to Medicare and Medicaid

patients

Centers for Medicare & Medicaid Services. HCAHPS Quality Assurance Guidelines. 2014 Mar.

Financial Drivers (FY 2016)

Value Based Purchasing

40%

25%

25%

10%

Outcomes Patient ExperienceEfficiency Clinical Processes

Available from: http://www.stratishealth.org/documents/FY2017-VBP-fact-sheet.pdf. Accessed 2015 Sept 1.

HCAHPS and Pharmacists

How does HCAHPS affect the way I take care of my patients?

• Pain Management• Patient Education• Transitions of Care

HCAHPS Survey Questions Directly Impacted by Pharmacists

Identified by Johns Hopkins Hospital Department of Pharmacy

• Q13: During this hospital stay, how often was your pain well controlled?

• Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?

• Q16: Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

• Q17: Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

• Q25: When I left the hospital I clearly understood the purpose for taking each of my medications.

Additional questions are still important!

Pharmacist-Driven Initiativesat Johns Hopkins Hospital

• Care Coordination Services

• Teach Back Competency

• “2 Patients per Day” Initiative

• Learner Huddle

• Pharmacy Ambassador Program

• SMART Goal

Department of Pharmacy HCAHPS Scorecard

At or above 75th percentile compared to entire nation

At least 3 percentage points improvement over last year (compared to “FY 2014 Baseline”)

Below 75th percentile nationally & < 3 percentile improvement

Looking Ahead

• HHCAHPS (Home Health)• CGCAHPS (Outpatient)• EDCAHPS (Emergency Department)• Pediatric CAHPS• Surgical CAHPS

Post-Assessment

Which of the following survey questions can pharmacists impact through direct patient care?

A. How often was your pain well controlled?

B. How often did hospital staff describe possible side effects in a way you could understand?

C. When I left the hospital, I clearly understood the purpose for taking each of my medications.

D. A, B and C

Key Takeaways

• Nationally, there is an increased focus placed on patient experience quality measures

• If we aim to improve patient experience and the care we provide, scores will follow

Acknowledgements

• Kimberly Sparks, Service Excellence• Jacob Smith, PharmD, MBA, Assistant

Director of Quality Improvement and Regulatory Affairs

• Todd Nesbit, PharmD, MBA, Director of Pharmacy Patient Care Services

Questions?

Image: http://www.clinicallinkages.com/wp-content/uploads/2014/03/HCAHPS-Zoomed-In-2.jpg