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Standardized Patient Surveys: The Latest Developments

Standardized Patient Surveys: The Latest Developments

by Robert Nielsen

For many patient care experts, publicly reporting hospital patient satisfaction ratings has all the appeal of an impending biopsy. It may have to be done, but the outcomes are hard to anticipate and potentially unpleasant. So anything that can be done to facilitate and simplify the process would be welcomed by the healthcare industry. In that light, I'd like to update Gallup's position on the initiative by the Center for Medicare and Medicaid Services (CMS) to establish a national patient satisfaction standard.

CMS, through the Agency for Healthcare Research and Quality (AHRQ) -- the research of arm of the U.S. Department of Health and Human Services -- has submitted its research plan for the pilot project to create a national standard for measuring the "hospital patient experience," otherwise known as H-CAHPS. A description of the pilot project has been released from the White House Office of Management and Budget (OMB) and the pilot will be conducted in hospitals in Maryland, New York, and Arizona.

Why Use the Patient Experience Model?

AHRQ and CMS mandated and assigned development of their patient experience model for this initiative with minimal competitive bidding. A cursory look at the model yields serious question marks with regard to its reliability, particularly given its considerable length and the expense required to administer it. As a commercial product, the patient experience model failed so miserably that it led to the bankruptcy of the company that created it. As a research tool, the results were so flawed that in a statewide program in Massachusetts, the hospitals agreed to never publicly release the results.

I am unaware of any hospital system that spends its own money on the CMS patient experience model. As currently applied in California and the United Kingdom, the model has proven misleading as to both the quality and the capabilities of hospitals, thus mitigating any salutary effect for consumers. When CMS announced the mandate for the patient experience model, the only supporters were a handful of shareholders in a publicly held research company -- the only company that offers the patient experience model.

I have absorbed substantial criticism from CMS administrator Tom Scully for questioning the proposed national patient standards program. But others in the hospital industry have also criticized the model as incongruous with the patient satisfaction programs already in place in almost every U.S. hospital. The choice to use this approach, when nearly all American hospitals are using the patient satisfaction model, heightens the cost and complexity of existing patient measurement programs, as well as the potential for confusion. As most hospitals have discovered, it's most effective to measure not the details of daily care -- many of which the patient may not remember clearly since the survey is often administered a month after discharge -- but the quality of the clinical outcomes from the patient's hospital experience, and the patient's satisfaction with the those outcomes.

Outcome-Driven Incentives

Recent developments regarding the initiative have not been all bad. In the May 27 edition of the Wall Street Journal ("Merit Pay for Top Hospitals"), Scully puts forth a new explanation of CMS' intentions. He states that CMS wants to "reward hospitals that provide superior care," by basing the quality score on clinical outcomes. Hospitals with "top scores on quality would get a small bonus -- 1% or 2% -- added to their regular Medicare payments," without punishing the low performers. Scully has stated that this "merit pay" plan will result in reduced costs associated with complications or readmissions.

I couldn't agree more. Rewarding hospitals for outstanding performance on effectively measured outcomes -- i.e., reduced medical errors, complications, and readmissions -- is a huge step in the right direction toward improving the quality of care.

Bottom Line

CMS has shown some wisdom in tying hospitals' merit-based incentives to specific clinical outcomes. In the long run, extra reimbursements to hospitals for outstanding performance based upon these outcomes will be more than paid for in reduced healthcare costs. If only the initiative wasn't seriously tarnished by its consumer satisfaction rating aspect, it would be worthy of wholehearted support.


Gallup https://news.gallup.com/poll/8533/Standardized-Patient-Surveys-Latest-Developments.aspx
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