HCAHPS: Making a Difference While There's Still Time

Philip Betbeze, November 11, 2015

Leaders must address organizational deficiencies before 2% of Medicare payments will be at risk in 2017.

This article appears in the October 2015 issue of HealthLeaders magazine.

Like it or not, HCAHPS scores are about to get a lot more attention from hospital and health system senior leadership.

It's not that they have ignored the scores in the past. Results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey have been publicly reported since 2008, so hospitals have had plenty of time and some incentive to address their current and future impact on their reputation and on reimbursement and, more holistically, to use them to try to deliver a better customer experience to their patients.

The problem is one of priorities. Some leaders have placed HCAHPS improvement initiatives lower on their list, given that penalties for poor performance have ratcheted up slowly over time.

Crunch time
In 2015, time is essentially up. In fact, HCAHPS scores will determine up to 2% of a hospital or health system's Medicare payments by 2017, and it's already to 1.5% in 2015. That's a lot of potential money. So improving the patient experience is getting plenty of attention as time grows ever shorter.

"It doesn't make sense to leave money on the table that we could be investing back in patient care because we're not achieving the scores we could be achieving," says Lauraine Szekely, senior vice president of patient care services and chief nursing officer at Northern Westchester Hospital in Mount Kisco, New York. Northern Westchester has achieved the highest rating from CMS (five stars) for patient satisfaction, she notes. "The financial part of this is not our primary mission but it's certainly important."

The survey has been pilloried since its inception for what it is not. Results from patient responses to its 27 questions don't deliver a measure of quality, and were never meant to. It's also not comprehensive, and many criticize that the survey twists motivations among healthcare providers so that they "teach to the test." Its focus on the word always regarding a patient's interactions with staff is a continuing area of disagreement.

Many of these challenges can lead to cynicism about the measures, and to attempts to game the system. But regardless of HCAHPS' failings, it delivers a piece of information that patients may use to decide where to receive care; so, for that reason alone, how a hospital does on it is an increasingly important and direct factor in its level of reimbursement. Perhaps the best way to describe HCAHPS is that it measures a customer's satisfaction—and as such, it's a valuable, if sometimes annoyingly incomplete, measure of a service attribute that most agree healthcare has largely lacked historically.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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