Embed Size (px)
Citation preview
Detroit Medical CenterGRAND ROUNDS
UROLOGY
HCAHPS:
Transparency and Patient Participation In Healthcare
KEVIN G. SIMOWSKI, J.D.
CORPORATE VICE PRESIDENT
CUSTOMER SERVICE
June 30, 2010
HCAHPS
Hospital
Consumer
Assessment of
Healthcare
Providers and
Systems
HCAHPS FACTS
Developed by CMS and AHRQ Participation required for hospitals to receive a full
IPPS payment update beginning 2007 All General Acute Care Hospitals Eligible Patients are 18 years old and over who have
had an overnight stay 300 surveys minimum over a rolling 12 month period
(25 per month)
HCAHPS Questions
Six Composite Areas: Communication with Nurses Responsiveness of Hospital Staff Communication with Doctors Pain Control Communication about Medicines Discharge Information
Two Individual Questions: Room Cleanliness Quiet at Night
Two “Global” Questions: Overall Rating of Hospital (0 to 10) Likelihood of Recommending the Hospital
DMC HCAHPS Results
The number of hospitals reporting their HCAHPS results has increased by 1,255 (50%) since the first public reporting in March 2008.
First line indicates Top Box* response for all U.S. hospitals from July 1, 2008 – June 30, 2009.
(3,775 hospitals and 2.4 million completed surveys)
Second line indicates Top Box* response for all Michigan hospitals for stated time period.
(131 hospitals)
*Top Box - percentage of patients that provided the most positive answers to the survey question
These results are from patients who had overnight hospital stays from July 1, 2008 – June 30, 2009
Patients reported how often their doctors communicated well with them during their hospital stay. “COMMUNICATED WELL” means doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect
Bars below tell the percent of patients who reported that their doctors “ALWAYS” communicated well.
Composite 2Communication with Doctors
During this hospital stay, how often did doctors:– Treat you with courtesy and respect?– Listen carefully to you?– Explain things in a way you could understand?
Never Sometimes Usually Always
COMPOSITE 2 Communication with Doctors
7578
727677
7372
7678
747980
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hosiptal - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
0
(-4)
0
0
0
+1
0
+2
0
+1
0
0
Composite 4Pain Management
During this hospital stay, how often:
– Was your pain well controlled?
– Did the hospital staff do everything they could to help you with your pain?
Never Sometimes Usually Always
COMPOSITE 4Pain Management
6868
626971
6762
6868
5770
68
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hospital - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
(-2)
(-1)
0
0
+1
+3
+2
+3
+1
+2
+2
(-2)
Composite 5Communication About Medicines
Before giving you any new medicine, how often did hospital staff:
– Tell you what the medicine was for?
– Describe possible side effects in a way you could understand?
Never Sometimes Usually Always
COMPOSITE 5Communication about Medicines
6055
4957
6052
505759
565959
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hospital - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
+2
(-2)
(-1)
0
+1
0
0
+2
(-1)
+1
(-1)
(-3)
Composite 6Discharge Information
During this hospital stay:
– Did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
– Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
YES NO
COMPOSITE 6 Discharge Information
867778
7584
7876
8078
768281
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hospital - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
0
0
(-1)
+1
0
0
0
+1
+1
0
0
+1
Overall rating of this hospital (0-10)
7364
6156
7064
5067
6357
6765
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hospital - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
0
(-2)
+4
0
0
+2
+3
+1
+2
+1
(-1)
(-3)
Willingness to Recommend this Hospital
806362
607172
4971
6564
6968
0 10 20 30 40 50 60 70 80 90 100
University of Michigan - Ann Arbor
St. John Hospital - Main
Providence Hospital
Oakwood Hospital - Main
Henry Ford Hospital - Main
William Beaumont - Royal Oak
DMC - Sinai Grace Hospital
DMC - Huron Valley Sinai Hospital
DMC - Harper University Hospital
DMC - Detroit Receiving Hospital
STATE
NATIONAL
0
(-1)
+3
0
0
(-1)
(-1)
0
0
0
+1
(-1)
Transparency
Hospital Compare Website page views (“hits”):– 157,500 two weeks prior to March 28, 2008 debut– 2.5 million in April 2008– 3.6 million in May 2008– 11.5 million in June 2008
Other Measures on Hospital Compare:– Surgical Care Improvement/Surgical Infections Prevention– Heart Attack/Heart Failure Process of Care Measures– Pneumonia Process of Care Measures– MORTALITY
IMPROVEMENT IDEAS
Introduce yourself to patient and family members Have a seat! Smile if appropriate. Explain your role on the health care team Provide pen and paper “Questions for our physician” Let patients/family know when you are available Provide realistic expectations
MORE STEPS
Ask, before you leave, if there is anything else they would like to discuss
Demonstrate empathy: “I understand this is a stressful time, is there anything I can do to help?”
Involve the patient in the decisions that are made Actively LISTEN (avg time is 20 seconds) Provide answers in understandable, nontechnical
language Ask colleagues in high performing areas
LANGUAGE
PROBLEM BETTER
BENIGN Harmless (Not Cancer)
DYSFUNCTION Problem
INTAKE What You Eat or Drink
COLLABORATE Work Together
DECUBITIS ULCER Bedsore
EDEMA Swelling
PATIENT COMMENTS (The “Good”)
“Physicians were very professional and courteous” “The doctor was very good and nice on explaining
everything to me and I appreciate it very much” “Although my father was hard of hearing,
physicians worked hard to make sure he understood what was going on”
“My doctor made me feel that she really cared…I looked forward to her arrival each day”
“LOVE my physicians”
PATIENT COMMENTS – Not so much
“The physician would not talk to you. You would wait all day to see one and they would be in your room 5 minutes.”
“He seemed to not have a very good bedside manner and was not there when I was out of surgery to answer questions”
“Doctor didn’t keep promise to come back, very poor in keeping word.”
“Staff physicians flew in and out and explained very little.”
SYSTEM QUALITY DASHBOARD
Press Ganey – Standard Physician Questions
Health Care Reform Legislation and the Impact on HCAHPS
Patient Protection and Affordable Care ActTitle III-Improving the Quality and Efficiency of Heath CareSection 3001. Hospital Value-Based Purchasing Program
Program to begin Fiscal Year 2013 (October 1, 2012)
HCAHPS measures among quality measures to be selected (along with AMI, Heart Failure, Pneumonia, infections)
Sec. 3001(a)(5)(B)(i) “Appropriate Distribution.” “(H)ospitals achieving the highest performance scores receiving the largest value-based incentive payments.”
– (ii) “(U)sing the higher of its achievement or improvement score for each measure”
Health Care Reform Legislation HCAHPS-NEXT STEPS
1% of payments tied to VBP in FY 2013, 1.25% in FY 2014, 1.5% in FY 2015, 1.75% in FY 2016 and 2% in FY 2017 and beyond
Inpatient Rehabilitation to begin quality reporting program in 2014.– VBP pilot to start by 2016
HCAHPS (Media) Coverage
1.14 million page views/month on Hospital Compare in 2009
Posted on Quality Check (Joint Commission) beginning in 2009
Consumer Reports August, 3, 2009
US News & World Report October 20, 2009
USA Today January 25, 2010
NEJM October 30, 2008
“(We) would like to reiterate that the full, complete and official HCAHPS results are those publicly reported on Hospital Compare.”
–CMS HCAHPS Executive Insight, March 2010.
RESOURCES
Hospital Compare www.hospitalcompare.hhs.gov
HCAHPS Info www.hcahpsonline.org
AHRQ www.ahrq.gov
HQA www.hospitalqualityalliance.org
JOINT COMMISSION www.jointcommission.org
PRESS GANEY www.pressganey.com
CONCLUSION
July 1, 2008 – June 30, 2009 data available to the public on CMS website as of March 18, 2010
300 surveys per site per year (25/month)
CMS rule ties HCAHPS participation to Medicare reimbursement in FY 2008 and performance in FY 2013
Additional information: www.hcahpsonline.org (“Executive Insight”) www.ahrq.gov www.hospitalcompare.hhs.gov
