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AHA Objects to New Patient Experience Surveys

 |  By John Commins  
   March 28, 2013

The American Hospital Association has a message for the federal government on the topic of patient experience surveys: Enough already!

In a letter this week to Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, AHA suggested that plans to add a new survey about patient experiences in hospital outpatient surgical departments and ambulatory surgical centers would be a lesson in overkill that would confuse patients and prove burdensome and expensive for hospital administrators.

Ashley Thompson, AHA's vice president and deputy director of policy, wrote in the letter to Tavenner that AHA has long supported and recognized the value of Consumer Assessment of Healthcare Providers and Systems surveys "as tools to help hospitals improve the engagement and satisfaction of patients and families."

"However, the AHA urges CMS to reconsider the necessity of a new, separate survey tool for ASCs and HOSDs," Thompson said in the letter.

"We are concerned that the CAHPS program already includes multiple overlapping survey tools creating confusion about how to assess the patient experience across multiple care settings, as well as excessive survey administration burden. Instead of a separate survey, CMS should incorporate a small number of supplemental survey questions targeted at facility-level issues for ASCs into an existing CAHPS survey."

AHA was responding to CMS's January 25 request for information that sought input from hospitals about the proposed survey. The comment period ended on Tuesday.

CMS acknowledged in its request for information notice that "two related CAHPS surveys exist: however, they do not collect information specific to the patient experience of care in HOSD/ASC facilities."

The Hospital CAHPS (HCAHPS) survey collects data on inpatient experience and care ratings but does not include patients who receive outpatient surgical care from a hospital-based outpatient surgical department or patients who got that care from freestanding ACSs, CMS said.

The Surgical Care CAHPS survey focuses on inpatient and outpatient surgeries and includes questions about the patient's experience before, during and after the surgery. However, the survey focuses on the care provided by the physician and not the facility, CMS said.

Thompson countered in her letter that the CG-CAHPS and Surgical CAHPS "already include information highly relevant to assessing experience of care in ASCs and HOSDs."

"The CG-CAHPS survey evaluates practices and individual providers on several issues, including access to appointments, physician communication with patients, courtesy of office staff and follow up on testing results," she said.

"The Surgical CAHPS survey captures similar information, but with a focus on surgical care in both the inpatient and outpatient settings. Patients rate the quality of pre-and-post procedure information provided to them, the helpfulness of office staff, and communication with surgeons and anesthesiologists before and after the procedure."

Thompson raised concerns that the "proliferation of CAHPS surveys" confuses patients and makes it difficult for them to accurately assess their experience

"If CMS implements yet another survey relevant to ambulatory surgical patients, then patients would receive three separate but similar surveys for exactly the same care episode," she said.

In addition, Thompson noted that CAHPS already survey physicians, hospitals, nursing homes, dialysis facilities and home health agencies, and there are plans to build surveys for emergency departments and hospice care.

"Patients who receive care in two or more of these settings could receive multiple surveys," Thompson said. "Typically, surveys are not distributed until days or weeks after a patient has received their care. This may create confusion about which provider or facility is actually being assessed. A patient may inadvertently attribute a positive or negative experience to the wrong organization."

Thompson raised concerns about the cost and administrative burdens of the surveys and suggested that CMS allow hospitals to choose lower cost surveys to mitigate the financial burden imposed by the process.

In addition, she said CMS could enhance existing CAHPS surveys by reassessing how scores are adjusted for the severity of patient illness. She pointed to a Cleveland Clinic study which found that patient satisfaction scores declined significantly as the severity of the illness worsens.

"These findings indicate that hospitals that treat the most severely ill patients may have systematically lower scores," Thompson said. "We believe this trend also may affect scores for other surveys in the CAHPS family. We encourage CMS to conduct an analysis that assesses the extent of the issue, and identifies potential mechanisms for enhancing how CAHPS scores are adjusted for patient factors."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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