Hospitals target patient experience ahead of reform

Starting this week, Medicare is basing hospital reimbursements on performance measures, with patient satisfaction determining 30 percent of the incentive payments and improved clinical outcomes deciding 70 percent.

Now that the value-based purchasing program has kicked in, we wanted to know how hospitals are prioritizing patient experience efforts to help boost satisfaction scores. However, most organizations have been focusing on improving patient experience well before the new regulations, according to healthcare executives.

"A lot of the activity really began before healthcare reform because the payers had already begun to focus on [patient experience]," Bob Sehring (right), CEO of ambulatory services at Illinois' OSF Healthcare, told FierceHealthcare. Although he noted that the new regulations and payment models have certainly accelerated the focus.

Such is the case at SSM Health Care in St. Louis, whose patient experience efforts stemmed from the belief that it's the right thing to do for patients. "While these efforts may not be directly linked to any specific healthcare reform regulation, reform has been a catalyst in shaping our strategy" SSM Chief Medical Officer Gaurov Dayal (left) told FierceHealthcare.

For James Merlino (right), chief experience officer at the Cleveland Clinic, patient experience has been a top priority at the hospital system since Toby Cosgrove took the reins back in 2004. But thanks to increased government pressure, the Clinic has been able to send a stronger message to physicians about why patient experience is so important.

"Physicians, who are typically difficult to engage in this area, have been refreshingly supportive to improve, as well, specifically in how physicians communicate with their patients, which is a critical domain in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey," Merlino said.

Despite the accelerated focus, problems remain, including incomplete or biased data and improper motivation to drive patient experience activity.

For example, poor response rates--which typically come in at less than 20 percent--might paint an inaccurate view of the patient experience,  according to Jesse Pines (left), director of the Center for Health Care Quality and associate professor of emergency medicine and health policy at George Washington University in Washington, D.C. "It ends up being the really happy and really unhappy people who fill out the experience surveys, and they may not reflect the average experience," he told FierceHealthcare.

The new payment models will help move patient experience efforts up the priority list, but the data behind it may not get better, Pines noted.

In addition to inferior data, patient experience efforts suffer from fragmented quality metrics. "Everyone has a different measure or combination of measures," said William Cors (right), chief medical quality officer of Pocono Health System in East Stroudsburg, Pa.

Cors doesn't expect significant progress until the industry has a national online hospital dashboard that includes patient satisfaction scores, incidence of never events, risk-adjusted clinical outcomes and readmissions for all patients and not only the CMS population.

Meanwhile, Jeremy Tucker (left), medical director of MedStar St. Mary's Hospital in Leonardtown, Md., told FieceHealthcare that better patient experience comes from cultural change and not simply a series of initiatives. "If the reason for doing patient experience is simply to get a better score on a test, you will fail," he said.

And that cultural change must take place at all levels of the organization, as "it only takes one cold meal tray or a roll of the eyes by a staff member to derail the patient experience," Tucker warned.