AAMC Reporter: January 2008

National Patient Care Survey Results to Go Public in March

In March, the federal government will begin publishing feedback from patients on their hospital experiences. Known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the standardized, nationwide patient survey is designed to educate consumers on hospital performance and foster hospital accountability and quality improvement.

"This is the first opportunity to address patient-centered care measurement and reporting information about what the patient actually experiences," said Jennifer Faerberg, health care quality liaison at the AAMC. "Hospitals may have patient surveys, but now we have a tool that offers national data and allows for apples-to-apples comparisons."

The HCAHPS is a survey instrument and data-collection tool that measures patients' perspectives of their hospital care. The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) developed this survey tool in collaboration with other stakeholders. The Hospital Quality Alliance (HQA), a private/public partnership that includes the AAMC and other major hospital associations, consumer organizations, government agencies including the CMS, and other groups committed to improving hospital quality, supported the implementation of the HCAHPS. HCAHPS will be posted on the Hospital Compare Web site www.hospitalcompare.hhs.gov, an online tool that reports on hospital performance.

The HCAHPS consists of 27 questions covering 10 aspects of care: six aggregate measures (staff responsiveness, communication with both nurses and doctors, medicine-related communication, pain control, and discharge information), and four individual items (cleanliness, quietness, overall satisfaction, and how highly it is recommended). Hospitals can add their own questions to the core survey. They can either employ an outside vendor to conduct the survey, or if qualified, run it themselves. Although participation is voluntary, it is tied to the Medicare annual payment update for reporting quality data.

The March posting will cover the HCAHPS data collected from Oct. 2006 to June 2007. Moving forward, the Web site will be updated every quarter. To familiarize hospitals with the process, the CMS administered a 2006 "dry run" based on three months of data collection. The federal agency also allowed hospitals to preview the first batch of results in mid-January to help prepare the hospitals for the March unveiling. CMS officials said HCAHPS will give hospital consumers—patients, their families, and referring physicians—more information with which to evaluate and select a hospital.

"This is an important piece of information for the public," said Elizabeth Goldstein, Ph.D., director of the CMS's division of consumer assessment of health care surveys. She added that "areas like responsiveness and communication are easier for lay people to understand and relate to."

The HCAHPS survey should eventually work both ways—by providing consumers with more information, and by spurring hospital staff to improve and maximize performance. HCAHPS has already induced some preemptive change: knowing that the survey results would be publicized has inspired hospitals to make employees more cognizant of the survey and considerate of these patient care measures.

"HCAHPS definitely has a 'sit-up and take notice' effect," said Ed Karls, manager for customer performance, metrics, and improvement at the University of Michigan Health System. "Because there had been some lead time before the survey started, we have been able to educate nurses and doctors about this."

Seeing their results in the context of the national data, of course, will be a much stronger driver for hospitals to boost their weak areas of patient care—and maintain or even increase their high marks.

"Hospitals will be able to see how they stack up compared with over 4,000 other hospitals," said Katherine Browne, managing director of the HQA. "This will help them target where to build their strengths and find opportunities for improvement."

Independent vendors who administer HCAHPS and other patient quality improvement surveys, she said, are a good resource for hospitals, because they also work to boost performance.

Janna Binder, M.B.A., director of marketing and public relations for Professional Research Consultants, Inc. (PRC), a Nebraska-based HCAHPS administrator, said her firm emphasizes improved communication skills when providing guidance on patient care to client hospitals. Better communication can not only directly help a hospital raise their scores on communication-related survey questions, but can help patients better understand other components of the care they are receiving that HCAHPS measures and hospitals may not have recognized before.

"If a hospital is scoring low on something they are confident they are doing well in, we encourage them to make sure that they are telling the patient what exactly they are doing. For example, we teach nurses and doctors to say things like 'Now I am pulling the curtain down for your privacy,'" Binder said.

Potential subjectivity among patients who take the HCAHPS survey, Faerberg said, is one of its limitations. To help alleviate this concern, Goldstein said that the CMS adjusts for known biases, such as maternal patients tending to rate their hospital experience higher and more educated patients giving lower-than-average scores. The HCAHPS does not cover pediatric and psychiatric populations, among a few other patient groups. As of now, the survey is only available in English, although there will eventually be a Spanish version.

—By Elissa Fuchs

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