Hospital HCAHPS Scores Beat Expectations

In the health reform sweepstakes to retrieve their share of $850 million in federal funds, hospitals have been scurrying to improve their patient experience scores under Medicare's value-based purchasing rules.

Now, according to the latest survey results, their efforts are paying off.

For discharges in July, 2011, the month scoring began, patients' responses were 0.7 % better than they were in June, according to Press Ganey Associates, which distributes and analyzes patient responses to the 27 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

That was double what Press Ganey expected, says Deirdre Mylod, Press Ganey's vice president, improvement services.

The pleasant surprise was based on the 0.7 % increase in how many patients, when asked the VBP survey question "Using any number from 0-10 where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?" gave the hospital a score of 9 or 10.

"It was exciting to us because it says that hospitals were gearing up, and have acknowledged, that in July at the beginning of the performance period,  they knew they needed to maximize their performance in order to earn as much of their money back (as possible) under value based purchasing," Mylod said. 

She added that her company provides survey services to comply with Medicare requirements for 44% of the nation's hospitals, which amounts to about 65% of discharges in the country. Press Ganey decided to take the extra step to give hospitals and the public some sense of how patients are responding to extra efforts hospital teams are making. Each of their client hospitals is receiving its own scores, with comparison tables for their regional, state or national competitors.

The Centers for Medicare & Medicaid also provides this information in public reports, but that data is delayed, with the most recent HCAHPS survey responses posted a week ago covering the period April 1, 2010 to March 31, 2011, now about one year old. "We have an opportunity to look at this robust sample of 44% of hospitals, to see what's really going on now in the industry as opposed to a year in hindsight," Mylod says.

Additionally, Press Ganey compared responses to that same question for discharges between April, 2010 to March 2011 survey responses from discharges July 1 to October 31, 2011. The improvement was even better—0.9%—or nine additional patients out of 1,000 giving the hospital a high score of 9 or 10.

Using a different question, one hospitals like to review, but which is not part of the HCAHPS survey used for VBP scoring—"How likely would you be to recommend this hospital to others?"—also showed improvement.Ofpatients discharged between July and October, 1.5% more would "definitely recommend" compared with the period April 2010 to March 2011.

Extrapolated to the 36.9 million patients discharged for the 12 month period, that would mean nearly 500,000 more patients would "definitely recommend" the hospital that provided them care compared with the prior 12-month period, Press Ganey officials said in a media statement.

Similar improvements were seen in various categories of the HCAHPS survey responses, Mylod says.

Asked what hospitals have been doing to improve, Mylod said that in general, hospitals that show solid improvement aren't just training staff on ways to do better. They are following up, rounding with patients and staff, called "manager rounding," to watch implementation.

Sometimes they are speaking with patients in their rooms privately to ask if they felt they got the information they needed or asked for, and, for example, whether their pain issues were addressed.

Of course, the fact that the group of hospitals in the aggregate improved their VBP scores does not mean each will win back its share of the $850 million, 30% of which rewards hospitals with higher patient experience scores or which show significant improvement.

Mylod gave this example: "When you're out in the woods with your friends and you're chased by a bear, you don't have to run faster than the bear.  You just have to run faster than your friends."

This Press Ganey sample did not examine regional differences, or spotlight any hospitals specifically for their high or low scores.  That will come when the results are posted by the Centers for Medicare and Medicaid Services on Hospital Compare. The first VBP scoring period ends March 31.