Effect change for quick wins and long-term value

With this post, we kickoff a short series on the increasingly important HCAHPS scoring system and its impact on your hospital’s continuing success. Back in the Wild West days of healthcare IT, patient satisfaction surveys were sporadic, arbitrary and scattershot. Often a hospital would mail a paper survey to patients, while on other occasions, certain patient populations would receive an email asking them a few basic questions.

Some facilities created comprehensive lists of questions with the goal of generating meaningful feedback and care delivery improvements. For many others, surveys were a mere box-check or weren’t conducted at all. If a patient went to five hospitals over the course of a year, they could expect to see five different approaches to asking for feedback, with little to no follow up on the results.

Raising the bar on patient feedback

Then in 2002, the Centers for Medicare and Medicaid Services (CMS) identified a need to bring consistency to the chaos. This division of the US Department of Health and Human Services is responsible for issuing reimbursements to healthcare providers in return for services provided to patients eligible for Medicare and Medicaid programs. At the most basic level, CMS needs to confirm patient eligibility, the necessity of care provision, and that a provider did in fact provide the care. Over the past two decades, the department started to take a closer look at many facets of care delivery and hospital operations, and developed measurable metrics that make such assessment easier and more consistent.

Whether you visit a hospital in New York, Des Moines, Los Angeles, or anywhere in between, CMS wants to compare and contrast the care you received, so it can evaluate those providing it on a level playing field. The aim is not assessment for its own sake, but rather to increase reporting and transparency that encourage higher standards across the board, across the country.

CMS decided that one way to do so was to develop “the first national, standardized, publicly reported survey of patients' perspectives of hospital care.” And so the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey came into being. Over four years’ time, CMS teamed up with the Agency for Healthcare Research and Quality (AHRQ) to research, design and test HCAHPS. And after several iterations, in 2006, the survey became a requirement for acute care hospitals nationwide, with initial results published in 2008.

Patient satisfaction in a Yelp world

The fact that these results are published publicly is a key point. While some patient satisfaction metrics may be retained by CMS and other government agencies without being made public, HCAHPS scores are available to everyone on the Hospital Compare website. This doesn’t just allow hospitals to measure performance, but also provides patients a way to objectively evaluate their care options. That’s something healthcare consumers increasingly demand in the age of online-research-before-you-buy—be it restaurant ratings on Yelp, evaluating education choices on Great Schools, or reading buyer reviews on just about anything on Amazon.

HCAHPS scores are based on 27 ratings of eight care areas:

  • Communication with doctors
  • Communication with nurses
  • Responsiveness of hospital staff
  • Pain management
  • Communication about medicines
  • Discharge information
  • Cleanliness of the hospital environment
  • Quietness of the hospital environment

Anytime numbers are in play, it can be tempting to focus on numbers alone as unequivocal validation for our choices or actions. Yet we’ve all heard cautionary tales about what happens when a business only thinks about its bottom line, a baseball team fixates on Moneyball metrics, or a school puts test results above effective learning. Simply put, the results aren’t good.

Though strong numbers may be a goal, the objective should be people-focused and sustained improvement. In the case of HCAHPS scores, hospitals shouldn't be short-sighted about simply raising numbers quickly, but rather they need to focus on improvements in all eight of these designated care areas that will have long-term value for patients and care providers, as well as sustained impact on HCAPHS scores.

Despite the value of strong HCAHPS scores on a hospital’s Medicare reimbursement—as much as plus/minus 2 percent—obsessing on the numbers themselves takes the focus off the critical factors that influence results—namely, patient care, service and satisfaction. Any step a hospital takes in response to its HCAHPS scores should be aimed at making patients healthier and happier in the long run, not simply giving your stats a shot in the arm.

In the forthcoming installments in this series, we’ll explore the far-reaching patient satisfaction effects of transitioning from paper-based forms to eSignature-enabled electronic forms. Learn how this fundamental change to your process can not only help improve your facility’s HCAHPS rankings, but most importantly, empower your administrative and clinical teams to deliver an optimal patient experience every time.



David Wells

Written by David Wells

After receiving his Juris Doctor degree, David oversaw clinical and administrative compliance and supervised the implementation of paperless initiatives at a large non-profit. He joined Access in 2008 and specializes in matching the right e-forms solution to the needs of corporate partners and their customers.