1

 HCAHPS  and  Novel  Ways  of  Leveraging  

Technology  to  Improve  Scores  by  Focusing  on  the  LEP  (Limited  English  Proficient)  and  

Deaf  PaFent  populaFons  

Presented  by  Kellie  Webb  &  Ty  Burgess  Sponsored  by  InDemand  InterpreFng  

2 INTRODUCING

Kellie  Webb,  MBA   PREMIER, INC Director  of  Collabora.ve  Opera.ons  

Bio

Kellie  Webb  has  oversight  of  the  Quality  and  Safety  Data  AnalyFcs  team  and  is  responsible  for  all  data  elements  related  to  the  Premier  collaboraFves.  Her  areas  of  experFse  are  regulatory  healthcare  strategy,  quality  performance  improvement  and  data  analyFcs.  Kellie  has  12  years  of  healthcare  experience  and  is  currently  pursuing  her  MBA  in  Healthcare  Policy  and  Leadership  through  Baylor  University.  

3 INTRODUCING

Ty  Burgess,  MBA   INDEMAND INTERPRETING Senior  Regional  Director      

Bio

InDemand’s  vision  is  to  ensure  every  paFent  receives  the  highest  quality  healthcare,  regardless  of  language,  cultural  background  or  disability.  We  deliver  the  most  experienced  medical  interpreters  and  highest  quality  video  technology  so  providers  have  the  language  access  they  need  to  deliver  the  best  possible  care.  

4

o  Review  of  HCAHPS  and  trends  in  the  industry.  o  Why  LEP  and  Deaf  paFents  should  be  considered  important  factors  in  HCAHPS  scores.  o  Why  offering  a  paFent’s  naFve  language  is  criFcal  to  paFent  saFsfacFon.    o  How  hospitals  can  leverage  technology  to  bridge  the  communicaFon  gap  and  improve  the  

paFent  experience.  o  MiFgate  the  risk  of  adverse  health  events  for  LEP  and  Deaf  paFents  

OBJECTIVES

Sponsored  by  InDemand  Interpre.ng  

5

Sponsored  by  InDemand  InterpreFng  

6

HCAHPS  OVERVIEW  

Sponsored  by  InDemand  Interpre.ng  

Presented  by  Kellie  Webb  

7

HCAHPS Overview

HCAHPS  stands  for  "Hospital  Consumer  Assessment  of  Healthcare  Providers  and  Systems"  and  it  is  a  naFonally-­‐standardized  survey  that  is  sent  to  paFents  following  a  healthcare  encounter.  Hospitals  must  submit  a  minimum  of  300  surveys  to  eligible  paFents  during  each  reporFng  period.  The  results  are  publicly  available  on  the  Hospital  Compare  website.  According  to  CMS,  HCAHPS  was  designed  to:    

•  Provide  consumers  with  helpful  comparaFve  informaFon  on  paFents’  perspecFves  of  care  when  choosing  a  hospital.  

•  Create  reimbursement  incenFves  for  hospitals  to  improve  the  quality  of  care  they  provide.  

•  Enhance  public  accountability  through  increased  transparency  of  hospital  care  quality  provided.  

Sponsored  by  InDemand  Interpre.ng  

8

The  HCAHPS  survey  measures  “how  o`en”  six  composites  of  care  occur  (never,  someFmes,  usually,  or  always),  along  with  a  quesFon  on  discharge  informaFon  and  overall  hospital  raFng.  The  PaFent  Experience  scoring  is  roughly  the  same  as  the  Clinical  Process  of  Care  Measures;  however,  hospitals  can  earn  up  to  20  consistency  points  based  on  how  well  their  single  lowest  score  compares  to  that  of  other  hospitals.  

9

HCAHPS Survey Dimensions

Communication with Nurses

Communication with Doctors

Responsiveness of Hospital Staff

Pain Management

Communication about Medicines

Hospital Cleanliness and Quietness

Discharge Information

Overall Rating of Hospital

1

2

3

4

5

6

7

8

Sponsored  by  InDemand  Interpre.ng  

10

30%

70%

30%

25%

45%

30%

30%

20%

20% 25%

40%

25%

10%

Active Performance Period-Most Domains

HCAHPS  con.nue  to  be  part  of  VBP  moving  forward  

Clinical  process                

PaFent  experience                

Outcomes                

Efficiency  

The Imperative

FY  2013   FY  2014   FY  2015   FY  2016  

11

FY 2017 Domains: Align with National Quality Strategy

Clinical  Care  –  Process  5%,  Outcomes  25%  

PaFent  &  Caregiver  Experience                

Efficiency  &  Cost  ReducFon                

Safety  

PaFent  &  Caregiver  Experience  25%  

Safety    20%  

Efficiency  &  Cost  

ReducFon  25%  

Clinical  Care-­‐  

Process  &  Outcomes    30  %  

Clinical  Care  —  Process  Clinical  Care  —  Process  Clinical  Care  —  Process  Clinical  Care  —  Outcomes  Clinical  Care  —  Outcomes  Clinical  Care  —  Outcomes    PaFent  &  Caregiver  Centered  Experience  of  Care    Efficiency  &  Cost  ReducFon    Safety  Safety  Safety  Safety  Safety  Safety  

AMI-­‐7a  IMM-­‐2  

PC  01  *NEW*  MORT-­‐30-­‐AMI  MORT-­‐30-­‐HF  MORT-­‐30-­‐PN  

 HCAHPS  

   

MSPB-­‐1    

CLABSI  CAUTI  

MRSA  *NEW*  C-­‐Diff  *NEW*  

PSI-­‐90  SSI  Pt  and  caregiver  experience:    

Baseline:  2013    Performance  period:  2015  

12

A  percent  of  inpaFent  base  operaFng  payments  are  at  risk  based  on  quality  and  efficiency  metric  performance      

 

1%  1.25%  

1.5%  1.75%  

2%  

FY  2013  

FY  2014  

FY  2015  

FY  2016  

FY  2017  

Inpatient Value-Based Purchasing (VBP)

13

•  A  budget  neutral  policy,  where  hospitals  must  fail  to  meet  targets  for  bonuses  to  be  generated  for  others  

•  Rewards  for  achievement  or  improvement  

•  Quality  measures  from  Hospital  Compare  measure  set    •  20  measures  (12  process/8  HCAHPS  dimensions)  in  FY  2013,    •  Adds  3  outcome  measures  (3  mortality)  in  FY  2014,  and  •  Adds  2  outcome  measures  and  1  efficiency  measure  in  FY  2015.  •  Removes  5  process  and  adds  1  process,  2  outcome  measures  in  FY  2016  

•  InpaFent  Quality  ReporFng  measures  are  “on  deck”  for  VBP  

Inpatient Value-Based Purchasing (VBP), Cont.

Sponsored  by  InDemand  Interpre.ng  

14

ACO  Measures:  –  Measures  for  use  in  establishing  quality  performance  standards  that  ACOs  

must  meet  for  shared  savings:  

 1 PaFent/Caregiver  Experience   CAHPS:  Gepng  Timely  Care,  Appointments,  &  InformaFon   NQF  #5,  AHRQ  

2 PaFent/Caregiver  Experience   CAHPS:  How  Well  Your  Providers  Communicate   NQF  #5  AHRQ  

3 PaFent/Caregiver  Experience   CAHPS:  PaFents’  RaFng  of  Provider   NQF  #5  AHRQ  

4 PaFent/Caregiver  Experience   CAHPS:  Access  to  Specialists   NQF  #5  AHRQ  

5 PaFent/Caregiver  Experience   CAHPS:  Health  PromoFon  and  EducaFon   NQF  #5  AHRQ  

6 PaFent/Caregiver  Experience   CAHPS:  Shared  Decision  Making   NQF  #5  AHRQ  

7 PaFent/Caregiver  Experience   CAHPS:  Health  Status/FuncFonal  Status   NQF  #6  AHRQ  

The Imperative

15

Stage 2: Meaningful Use

Mandates  that  5  percent    of  paFents  view,  download,  and  transmit  their  own  

health  data  

16 “The  most  direct  route  to  the  Triple  Aim  is  via  paFent  and  family-­‐centered  care  in  its  fullest  form”  

Don  Berwick    (6/5/2012)  

Health  of  Popula.ons  

Reducing  Costs  Pa.ent  Experience  

www.IHI.org  

17

Fragmented  Care  

Provider  Centered  

Payment  for  Volume  

FaciliFes  Focused  

Physician  Accountability  

Paper  

Episodic,  Hospital  Based  Care  

Inconsistent,  Variable  Methods  

Cost  ReducFon  

Today’s Healthcare System Actual Sales Achieved

What  is  driving  PaFent  Experience  as  a  priority?  

Coordinated  Care  

PaFent  Centered  

Payment  for  Value  

Care  Systems  Focused  

Care  Team  Accountability  

Electronic  

Longitudinal,  MulF-­‐Site  Care  

Efficient,  Evidence  Based  Care  

Cost  Restructuring  

Today’s  Healthcare  System   The  Future  of  Healthcare  

18 Culture of Patient and Family Engagement = Excellent clinical outcomes

Harm  Reduced  

Lower  Mortality  

Proper  ED  Visits  

Reduced  Readmissions  

Less  Risk  

Lower  Costs  

PFE

19 PaFent  Experience  Driver  Diagram  

Improve  PaNent  and  

Family  Experience  

GOAL

Nurse  CommunicaNon  

Responsiveness  of  Staff  

Pain  Management  

Discharge  InformaNon  

Cleanliness  

Physician  CommunicaNon  

CommunicaNon  about  Medicines  

PRIMARY DRIVERS

Quietness  

Purposeful Rounding using 4 P’s

Pain control utilizing pain scale, using multi modal

strategies

Explain new medication using fact sheet

Quiet hours, close doors, lower volumes of alarms and

phones

Written/verbal Discharge instructions, medications, follow up care, teach back

Courtesy, Respect, Listen, Explain, Compassion, AIDET

Handoff Communication

SECONDARY DRIVERS

20

Why  hospitals  should  consider  LEP    and  Deaf  paFents  as  an  important  factor  in  

HCAHPS  scores?  

Sponsored  by  InDemand  Interpre.ng  

Presented  by  Ty  Burgess  

21

What is LEP? (Limited English Proficient)  

Sponsored  by  InDemand  Interpre.ng  

22

Sixty million people, (1 out of 5) speak A language other than English in their home Twenty-five million people speak English less than very well  

Sponsored  by  InDemand  Interpre.ng  

23

1980 1990 2000 2010

24

The  chance  of  miscommunicaFon  increases  dramaFcally  with  LEP  paFents  

Sponsored  by  InDemand  Interpre.ng  

25

26

What  impact  do  these  paFents  have  on    HCAHPS  scores?  

27

Nurse  CommunicaNon  

Responsiveness  of  Staff  

Pain  Management  

Discharge  InformaNon  

Cleanliness  

Physician  CommunicaNon  

CommunicaNon  about  Medicines  

Quietness  

Primary HCHAPS Measures Driven By Language    

17  Ques7ons  

2  Ques7ons  

2  Ques7ons  

28

HCAHPS  is  Currently  Available  in  5  Languages      

English,  Spanish,  Chinese,  Russian  and  Vietnamese  in  the  mail  formats  English  and  Spanish  in  telephone  and  script  formats.    

 

29

Source:  hsp://ahd.com/free_profile.php?hcfa_id=62b2dc9da3261e896f7aa6ca24d182ab&ek=2274eae715c48256f72987537cb1e556  

Patient-Mix Adjustment (PMA) for Non-English Speaking Patients

30 Words

7%

Vocal Elements

38%

Facial Expressions,

Gestures, Posture, Etc

55%  

How  Much  of  CommunicaFon  is  Really  Non-­‐verbal?  

Sponsored  by  InDemand  Interpre.ng  

Source:  hsp://www.nonverbalgroup.com/2011/08/how-­‐much-­‐of-­‐communicaFon-­‐is-­‐really-­‐nonverbal/    

31

How  InterpreFng  Affects  LOS  

Source:  The  Effect  of  Professional  InterpretaFon  on  InpaFent  Length  of  Stay  and  Readmission  Rates,  Mary  Lindholm,  Connie  Camelo  &  Lee  Hargraves,  2012  

32

•  “Gepng  By”  •  Ad-­‐hoc  InterpreFng  “hey  you”  •  Volunteer  Interpreters  •  Professional  On-­‐Site  Interpreters  •  Phone  InterpreFng  •  Video  Remote  InterpreNng  (VRI)  

Different Types of Interpreting

 

Sponsored  by  InDemand  Interpre.ng  

33

What is VRI ?  

34

Sponsored  by  InDemand  Interpre.ng  

By  adding  technology  called  Video  Remote  InterpreFng  (VRI),  hospitals  and  clinics  can:    •  Improve  paNent  saNsfacNon  (HCAHPS)  •  Minimize  risk  •  Lower  cost  per  paNent  encounter  by  30–70%  •  Improve  paNent  care  and  workflow  

The Benefit of VRI

35 Improve the Patient Experience

of Patients Prefer VRI Over Phone Interpreting

LEP  and  Deaf  paFents  someFmes  have  to  wait  for  hours  unFl  an  interpreter  shows  up.  With  interpreFng  services  on  demand,  they  no  longer  have  to  wait.  

No  WaiNng  

Being  able  to  see  an  interpreter  as  well  as  hear  them  makes  a  big  difference  for  paFents.  They  can  gesture  and  make  eye  contact  with  who  is  there  to  help  them.  

See,  as  Well  as  Hear  

HCAHPS  scores  are  o`en  lower  with  limited-­‐English  paFents,  and  survey  response  rates  are  o`en  lower.  Let  us  show  you  how  we  can  help.  

Improve  HCAHPS  Scores  

In  a  2013  study  done  at  Ann  &  Robert  H.  Lurie  Children’s  Hospital  in  Chicago,  91%  of  paFents  preferred  VRI  over  phone  (the  remaining  9%  had  no  preference)  

PaNents  Prefer  VRI  to  Phone  

Average  RaNng  (1-­‐10)  

Overall  experience   9.49  

Speed  of  access   9.46  

Ease  of  use   9.43  

Interpreter’s  overall  effecFveness  in  facilitaFng  communicaFon  

9.22  

Ability  to  understand  the  interpreter   9.28  

Your  confidence  that  interpreter  is  transmipng  messages  completely  and  accurately  

9.22  

Interpreter’s  customer  service  skills   9.23  

*Source:  private  survey  done  at  Ann  &  Robert  H.  Lurie  Children’s  Hospital,  2013  

91%  

36

Is VRI Expensive?

•  Finding  the  right  mix:  VRI,  phone,  onsite  •  Eliminates  scheduling  headaches,  missed  appointments,  waits  for  an  interpreter  •  IllustraFve  savings:  $1.5-­‐2M  on  a  $5M  budget  

Onsite  $60  per  

encounter  70%  

Phone  $15  per  

encounter  30%  

Average  cost  per  encounter:  $46.50  

Onsite  $60  per  

encounter  15%  

Phone  $15  per  

encounter  10%  

Average  cost  per  encounter:  $23.25  

VRI  $18  per  

encounter  75%  

37

o  hsp://www.lep.gov/demog_data/demog_data.html  

o  hsp://www.hcahpsonline.org/surveyinstrument.aspx  

o  hsp://www.census.gov/hhes/socdemo/language/data/language_map.html  

o  hsp://www.census.gov/hhes/socdemo/language/data/index.html  

o  hsp://www.nonverbalgroup.com/2011/08/how-­‐much-­‐of-­‐communicaFon-­‐is-­‐really-­‐nonverbal/  

o  hsp://www.hcahpsonline.org/files/Report_December_2014_States.pdf  

o  hsp://ahd.com/free_profile.php?hcfa_id=62b2dc9da3261e896f7aa6ca24d182ab&ek=2274eae715c48256f72987537cb1e556  

References

Sponsored by InDemand Interpreting

38

Q & A

39

Thank You.

Sponsored by InDemand Interpreting