Post on 17-Dec-2015
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The HCAHPS and Competency ConnectionHealthStream, Inc.
OBJECTIVES:
• Understand the HCAHPS initiative and VBP
• Identify key components of HCAHPS that are linked to competency
• Explore the impact of competencies on HCAHPS performance
• Discover how to select appropriate competencies
• Learn how to standardize competency selection process
• Uncover ways to promote employee accountability
To improve the quality of healthcare
by assessing and developing the people that deliver care.
VISIONHealthStream’s
Actionthroug
h Learnin
g
Insightthroug
hResear
ch
Measurement Learning
Improved Performan
ce
VBP Report Card
Learning Platform
Improvement Courseware
Call Center
HCAHPS Impact Report
Insights Online
Understanding the HCAHPS Initiative and Value Based Purchasing
What is CAHPS?
Consumer Assessment of Healthcare Providers and Systems
• H-CAHPS: Hospital Inpatients• HH-CAHPS: Home Health Patients• CG-CAHPS: Physician Clinic & Group Office Patients• ICH-CAHPS: In-Center Hemodialysis Patients• LTC-CAHPS: Nursing home residents and family
members• More to come!
Differences in Survey Question Scales
Overall, how would you rate the care you received?
Very Good Good Fair Poor Very Poor
53% 22% 14% 9% 2%
During this hospital stay, how often did nurses explain things in a way you could understand?
Always Usually Sometimes Never
40% 25% 25% 5%
The H-CAHPS Survey• Six Domains
• Communication with nurses• Communication with doctors• Responsiveness of hospital staff• Pain management• Communication about medicines• Discharge information
• Two Individual Questions• Cleanliness of hospital• Quietness of hospital
• Two Overall Questions• Overall hospital rating (0 – 10 point scale)• Would recommend (4 point scale-definitely yes)
HCAHPS USES FREQUENCY
SCALE:
Always
Usually
Sometimes
Never
Data Adjustments
CMS will take the data collected and adjust for…
• MODE: type of methodology used (phone vs. mail vs. mixed)
• PATIENT MIX: Service line, age, education, health status, language spoken in home, time since discharge, etc.
Public Reporting of H-CAHPS ResultsHow often did nurses communicate well with patients?
www.hospitalcompare.hhs.gov
Patient Protection and Affordable Care Act
VBP: Value Based Purchasing Program
• Enacted March 23, 2010
• Repealed January 19, 2011
• A specified percentage (1-2%) of hospital payments will be conditional on performance
• Critical Access Hospitals were not previously required to participate in HCAHPS
Value Based Purchasing (VBP)
• CMS released VBP details January 7, 2011
• A percentage of a hospital’s base DRG rate is impacted
• Reimbursement FY2013: 1.00% of payments• Reimbursement FY2014: 1.25% of payments• Reimbursement FY2015: 1.50% of payments• Reimbursement FY2016: 1.75% of payments• Reimbursement FY2017+: 2.00% of
payments70% of reimbursement based on 15 clinical and outcome
measures
30% on HCAHPS survey results
MBQIPMedicare Beneficiary Quality Improvement Project
• Office of Rural Health Policy (ORHP):
“This initiative takes a proactive approach to ensure CAH’s are well prepared to meet future
quality requirements.”
• September 2012 – Phase II Began – included HCAHPS
• “Voluntary”
Identifying Key Components of HCAHPS Linked to Competency
The H-CAHPS Survey• Six Domains
• Communication with nurses• Communication with doctors• Responsiveness of hospital staff• Pain management• Communication about medicines• Discharge information
• Two Individual Questions• Cleanliness of hospital• Quietness of hospital
• Two Overall Questions• Overall hospital rating (0 – 10 point scale)• Would recommend (4 point scale-definitely yes)
HCAHPS USES FREQUENCY
SCALE:
Always
Usually
Sometimes
Never
Hospitals Nationally Are Achieving High Scores
Top Box Results from the CMS National Database
(2nd Quarter 2011 Release)
Discharge Information 81% Willingness to
Recommend 68%
Doctor Communication 80% Overall Rating of
Hospital 66%
Nurse Communication 75% Responsiveness
of Staff 63%
Cleanliness of Room / Bathroom 70% Communication
about Medicines 59%
Pain Management 69% Quietness 57%
DateJul `07 - Jun `08
Oct `07 - Sep `08
Jan `08 - Dec `08
Apr `08 - Mar `09
Jul `08 - Jun `09
Oct `08 - Sep `09
Jan `09 - Dec `09
Apr `10 - Mar `11
Change over 2 years
Hospital Count 3,711 3,746 3,765 3,766 3,775 3,773 3,792 3,798
Nurse Communication 74% 74% 74% 74% 75% 75% 75% 76% 2%
Doctor Communication 80% 80% 80% 80% 80% 80% 80% 80% --
Responsiveness of Hospital Staff 62% 62% 62% 62% 63% 63% 63% 64% 2%
Pain Management 68% 68% 68% 68% 68% 69% 69% 69% 1%
Communication About Medicines 59% 59% 59% 59% 59% 59% 60% 60% 1%
Cleanliness of Room/Bathroom 69% 69% 69% 70% 70% 70% 70% 71% 2%Quietness of Area Around Room at Night 56% 56% 56% 56% 57% 57% 57% 58% 2%
Discharge Information 80% 80% 80% 80% 81% 81% 81% 81% 1%
Overall Rating of Hospital 64% 64% 64% 65% 65% 66% 66% 67% 3%Willingness to Recommend Hospital 68% 68% 68% 68% 68% 68% 69% 69% 1%
HCAHPS Composite 68% 68% 68% 68% 69% 69% 69% 70% 2%
HCAHPS Overall Performance
Exploring the Impact of Competency on HCAHPS
Linking Employee and Physician Satisfaction and
Competencyto HCAHPS Results
Results of a Recent Multivariate Study: Employee and Physician Predictors of HCAHPS Scores:
What factors/variables predict HCAHPS scores?
Methodology
Sample:
The sample included 237 HealthStream client hospitals.
Data used were employee satisfaction scores, physician satisfaction scores and HCAHPS inpatient scores. Total Beds and Average Length of Stay were obtained from an external data source.
Methodology• A multiple regression analysis was conducted on the data.
• Independent (predictor) Variables:• Employee Ratings of Administration• Employee Ratings of Immediate Supervisor• Employee Satisfaction/Loyalty• Physician Ratings of Administration• Physician Ratings of Hospital Efficiency• Physician Ratings of Nursing Skill• Total Beds• ALOS
• Dependent Variable:• HCAHPS Overall Hospital Score
Summary of HCAHPS Predictors
Three variables significantly predicted HCAHPS scores:
Significant PredictorsStandardiz
ed Beta Significance
Employee Satisfaction & Intent to Stay .78 p<.001
Employee Perceptions of Upper Management -.46 p<.001
Physician Perceptions of Nursing Skill .27 p<.001
Implications• Employee satisfaction/loyalty and HCAHPS
scores• Employee satisfaction is critical to inpatient care
• Physician rating of nursing skill and HCAHPS scores• Importance of physicians’ perceptions of nursing
skill
• Employee ratings of administration and HCAHPS scores• This unexpected finding can help administrators
understand potential low employee administration ratings in the quest toward HCAHPS improvement efforts
Questions?
Kylie B. TaylorRegional Director(443) 744-0299
kylie.taylor@healthstream.com