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15 HCAHPS Buzzwords Every Provider Should Know

 |  By cclark@healthleadersmedia.com  
   July 11, 2011

The value-based purchasing sweepstakes race is on. It's hospital against hospital in a national contest to see which acute care teams can please their patients the most on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

The prize is a chance to win back each facility's share of $850 million that will be deducted from Medicare's payments to 3,500 hospitals in FY 2013. That's 1% of each hospital's Diagnostic Related Group payment.

How patients answer 17 questions posed in Medicare's HCAHPS survey determines 30% of each hospital's score. The clock started ticking for patient stays on July 1, and will stop with discharges as of March 31, 2012.

How each hospital ranks will be publicly reported on HospitalCompare.gov, so not only will providers see how they ranked, but patients will see too. 

Patient experience surveys can be tough, with responses varying according to types and geographic locations of hospitals, whether they are urban or rural, serve sicker or healthier patients, are overcrowded, and whether they have an expansive list of racial and ethnic populations which can make communication far more difficult.

Though the scorekeepers determining the winners and losers say they have adjusted for most variables, many providers remain concerned.

We've interviewed a number of HCAHPS experts to get a sense of the lingo they are using as teams gear up to be evaluated. The following is a list of increasingly popular phrases generated by value-based purchasing regulations.

1. Service Recovery Mode
Hospital teams enter this phase of care after something has gone wrong. Call bell wasn't answered? Lab tests came back late? Housekeeping neglected to clean the bathroom?

At some facilities, the recovery effort may mean a visit from the chief nursing officer or even the CEO. At others, it may mean a free coupon for coffee or a magazine at the hospital gift store. For really big hospital mishaps, Service Recovery Mode may involve a significantly greater interventions.

2. Turn on the H.E.A.T
A form of Service Recovery Mode, the acronym stands for:
  • Hear, which also means don't interrupt the patient as he or she explains what went wrong
  • Empathize with the patients' frustrations and say you understand their disappointment and concern
  • Apologize for any oversights or mishaps, and
  • Take action, explaining to the patient and their family members exactly what your team intends to do to fix the problem and make sure it does not happen again.
3. "Yack Track" or "Yap Track"

A device that may be placed in parts of the hospital, such as around the nurse's station, a yack track resembles a traffic light and indicates when decibel levels have reached an unacceptable level. It may serve as a warning, especially during noisier periods, such as shift change. Hospitals install these in an effort to score better on one of their most challenging HCAHPS metrics, quietness, so patients can rest or sleep.

4. A.Y.R. At Your Request

This increasingly frequent feature of hospital inpatient dietary service allows patients and their family members or caregivers to select from a variety of menu choices, much like dining in a restaurant. Having a choice of food seems to improve patient experience scores.

5. NPZ or No Pass Zone

In an effort to engage all members of a hospital's workers in the care of any patient, some facilities are labeling hallways and patient rooms with this term to discourage anyone from walking by a lit call button without peeking inside and asking the patient what they might need.

In some hospitals, NPZ status means that even caregivers who don't work on that floor should not hesitate to pick up a piece of trash, move a wheelchair out of the way or perform any other necessary service that obviously needs to be done.

6. Hearts and Minds

A philosophy echoing president Lyndon Johnson's quote about the conflict in Vietnam: "the ultimate victory will depend on the hearts and minds of the people who actually live out there." The phrase calls for healthcare teams to be fully engaged in convincing patients that the providers' mission is to take care of patients in the best way possible. If patients' hearts and minds are convinced they're in good hands, their praise in survey responses will follow. If caregivers' hearts and minds are fully engaged, that is more likely to happen.

An acronym developed by The Studer Group, indicating "The Five Fundamentals of Service." It stands for:

  • Acknowledge – Acknowledge the patient by name. Make eye contact. Ask: "Is there anything I can do for you?"
  • Introduce – Introduce yourself, your skill set, your professional certification, and experience.
  • Duration – Give an accurate time expectation for tests, physician arrival, and tray delivery.
  • Explanation – Explain step by step what will happen, answer questions, and leave a phone number where you can be reached.
  • Thank – Thank the patient for choosing your hospital, and for their communication and cooperation. Thank the family for assistance and being there to support the patient.
8. Teachback

A delicate process in which the caregiver attempts to make sure the patient and/or their family members understand what they have been told without insulting them or making them feel inferior. The caregiver should say something like, "I'm not sure I've explained this well, so if you don't mind, please tell me what you think I was trying to say."

9. Judgment Dates

The baseline period for determining performance for comparison was July 1, 2009 to March 31, 2010. Hospitals can receive credit for improvement if their scores during the payment determination period, which runs from July 1, 2011 to March 31, 2012 are significantly better.

10. "Teach to the Meet" or "Teach to the Test"

A practice, generally frowned upon, in which hospitals and caregiver teams put all their efforts on improving just those areas that are the basis for value-based purchasing payment scores. The concern is that by putting resources into just those areas, other areas of hospital care may be neglected.

11. CGCAHPS

The Clinician and Group CAHPS (CGCAHPS) survey is similar to HCAHPS. This standardized tool to measure patients' perceptions of care provided by physicians in an office setting will soon become the basis for value based purchasing incentives for specific physicians.

12. Minimum 300

The number of completed patient HCAHPS surveys that must be turned into the Centers for Medicare and Medicaid Services for the first FY 2013 payment determinations.

13. Exchange Function

A complex mathematical formula by which scores for multiple questions and metrics are weighted, adjusted, and translated into an overall score for total performance.

14. DRG Reduction

All hospitals will have 1% of their Medicare payments under DRG schedules reduced for FY 2013, but the percentage of reduction becomes greater in subsequent years, 1.25% for FY 2014, 1.5% for FY 2015, 1.75% for FY 2016, and 2.0% for FY 2017 and subsequent years

15. Critical Dates

By Aug. 2, 2012, or 60 days prior to Oct. 1, 2012, CMS will publicize each hospital's estimated performance score and value-based incentive payment for FY 2013.

On Nov. 1, 2012, each hospital will learn the exact amount of its adjustment.

CMS will not provide notification to hospitals of the exact amount of their value-based incentive adjustments until November 1, 2012.

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