Achieving 24/7 Excellence—as Measured by HCAHPS

The Affordable Care Act of 2010 mandates that CMS implement the Hospital Value–Based Purchasing (VBP) Program, which incorporates several quality domains. One of these quality domains is the Patient Perspective of Care, assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

No organization can afford to ignore the ramifications of low patient-satisfaction scores because the Patients’ Perspective of Care survey, or HCAHPS, accounts for 30% of a hospital’s total VBP plan. This at-risk income—CMS calls it incentive reimbursement—is based on the patient’s experience and represents the potential for millions of dollars in lost revenue for many hospitals over the next five years.

The HCAHPS measurement criteria includes communication with nurses, communication with doctors, responsiveness of hospital staff, pain management, communication about medicines, cleanliness and quietness of hospital environment, discharge information and overall rating of hospital.

One of the greatest challenges of the HCAHPS survey is that the federal government’s evaluation survey is sent to the patient several weeks post-discharge: It is common knowledge that one very effective way to improve quality performance is with immediate, objective feedback.

Is your organization prepared to address all of the responses in detail, proactively determining reimbursement that hinges on HCAHPS results? These measures, which undeniably are important, put the hospitals in a losing position when they are trying to maximize revenue reimbursement from Medicare, yet organizations that ignore the HCAHPS risk of both reputation and revenue.

Because the HCAHPS survey results take so long to distribute and retrieve, it can cripple a hospital’s or healthcare provider’s effort to immediately resolve a patient’s concerns, let alone do so far in advance of several weeks post-discharge. Too often, it takes months to receive the data from CMS, making it almost impossible to implement effective, and certainly proactive, preventative change in an organization. Additionally, when a patient waits six to eight weeks to hear back from a hospital or healthcare provider about a concern filled out on the survey, he or she is often left more dissatisfied than with the initial encounter. A patient actually told me if we cared about his concern we should have resolved the issue weeks ago when he was still in the hospital.

Instantaneous feedback

Community Hospital of the Monterey Peninsula (CHOMP) in Monterey, Calif., with the support of our CEO Steven Packer, MD, is now incorporating instantaneous electronic feedback to improve the inpatient and outpatient experience. We’ve discovered that our promise to our patients—“when it comes to your health everything matters”— is more fully implemented when real-time listening and follow-up accompany our services.

Excellence 24/7 (E 24-7), which began in the radiology department, is based on QR bar codes displayed throughout the hospital to initiate and manage real-time, patient-initiated electronic communication at a cost of $1,500 per month. Using a free scanning app and a smart device, the scanned bar code triggers one question: “If we have exceeded your expectations or fallen short, please let us know how we can help.”

If patients respond, their message is instantly routed to a hospital management team member for immediate attention. In most cases, the patient and management team member meet face-to-face within minutes, sometimes seconds, after a concern is communicated.

Imagine the impact an immediate response has upon a patient. Healthcare is about life and death, and the more directly and immediately the patient is involved, the more positive the patient’s experience. E-24/7 has changed, for the better, patient perceptions of CHOMP. Our approval scores doubled following the implementation of E-24/7 in October 2013 (Figure 1, page 11).

The most dramatic payoff is that the patient is shown respect and attention while still in the hospital. E-24/7 puts the patients in control of what is important to them prior to being discharged. As a direct result Community Hospital has created a patient-centric, portable, easily accessible, straightforward closed-loop-patient-satisfaction program.

Employee performance scores alsohave improved significantly, because corrective behavior is tied to real-time responses. Effective behaviors are recognized and praised immediately, while the patient encounter is still embedded in short-term memory. Likewise, less-than-favorable employee behaviors are discovered sooner rather than later and are corrected through immediate conversations or on-the-spot training for more effective patient service.

E-24/7 is not just working in radiology, it is performing in every department in the hospital. Team members from registration and clinical areas to discharge and billing are engaged in continuous-improvement behaviors in order to exceed patient expectations. CHOMP’s Excellence 24/7 process provides immediate and actionable information. In our experience, the results speak for themselves.

Eric B. LoMonaco is director of diagnostic and interventional radiology, Community Hospital of the Monterey Peninsula, Monterey, Calif.