1. © Planetree 2013
Patient-Centered Strategies
for HCAHPS Improvement
Presenter:
Michael Lepore, PhD, Director, Research , Quality and Evaluation, Planetree
May 8, 2013

2. © Planetree 2013
Overview
• HCAHPS Basics
• Patient Experience as a Healthcare Priority
• From Improving HCAHPS Scores to Changing the Culture
of Care Delivery
• Patient-Centered Strategies for HCAHPS Improvement

3. © Planetree 2013
HCAHPS 101
Hospital Consumer Assessment of
Healthcare Providers and Systems

4. © Planetree 2013
HCAHPS 101
• A tool that asks patients about their hospital experiences
• A method for collecting standardized patient experience data
• A method for adjusting data for equitable comparisons and
benchmarking
• A mechanism for publicly reporting results
• Incentives for using to improve hospital quality of care

5. © Planetree 2013
• Dec. 2012 publicly reported scores are based on more
than 2.9 million completed surveys from patients at
3,892 hospitals
• Every day more than 7,900 patients complete the
HCAHPS survey

6. © Planetree 2013
Improving the patient
experience is a priority

7. © Planetree 2013
HCAHPS and the Quality Connection
“HCAHPS performance is more predictive of readmission rates
than the objective clinical performance measures often used to
assess the quality of hospital care.”
Boulding et al. in American Journal of Managed Care, 2011
“Two overall measures of hospital performance, the overall rating
of the hospital and willingness to recommend the hospital, had
strong relationships with better technical performance in
processes of care related to pneumonia, CHF, myocardial
infarction, and for surgical care.”
Isaac et al. in Health Services Research, 2010

8. © Planetree 2013
Elevating the importance of patient experience measures
Value-Based Purchasing:
Transition from pay for reporting to pay for performance
• Points earned for:
– Achievement
– Improvement
– Consistency (HCAHPS)

9. © Planetree 2013
2013 Value Based Purchasing Domains
• AMI
• Heart Failure
• Pneumonia
• Surgical Care Improvement
• Healthcare Associated Infections
Clinical Process of
Care Domain
(12 measures)
• HCAHPS measures
• 7 composites & 1 global measure
• Does not include Likelihood to
Recommend
• Quiet at Night and Cleanliness
rolled into one composite
Patient Experience
of Care Domain
(8 measures)
70%
30%

10. © Planetree 2013
Proposed 2014 Value Based Purchasing Domains
25%
Outcomes
45% Clinical
Process of Care
30% Patient
Experience
of Care

11. © Planetree 2013
HCAHPS Performance
30% of Total
National Median VBP Score 54
Score Needed to Maximize Medicare
Reimbursements Under VBP
70
National Median Score on Clinical
Measures
64
Score on Clinical Measures Needed to
Maximize Reimbursement
81
National Median HCAHPS Score 21
HCAHPS Score Needed to Maximize
Medicare Reimbursements
61

12. The heart of the
matter –
relationships and
communication.
“I find that if the doctors
would just talk in my terms
instead of these long
words, that would help. I
am not a doctor; these
words don’t mean nothing
to me.”
-

13. © Planetree 2012© Planetree 2012
A Consistent Finding: It’s All About Culture
• High performing sites credited their success not to specific
practices, but to a well-established culture of patient-
centered care
• High performing sites had implemented a comprehensive
approach to patient engagement, family involvement and
staff engagement

14. © Planetree 2012
Need list of
members
From Improving HCAHPS Scores to
Changing Health Care Cultures: Planetree

15. © Planetree 2012© Planetree 2012
Individual
Team
Industry Advocate
Solution
Provider
Standard
Setter
Who is Planetree?

16. © Planetree 2013
Advocating for what patients and caregivers need and want
Compassionate Human Interactions
Access to Meaningful Information
Support & Participation of Family, Friends
Healing Environment
Support for body, mind & spirit
Arts and Entertainment
Spirituality
Caring Touch
Integrative Therapies
Healthy Food and Nutrition

17. © Planetree 2013
Planetree Model
Components
HCAHPS Categories
Compassionate Human Interactions
Communication with Nurses
Communication with Physicians
Responsiveness
Pain Management
Care Transitions
Overall Satisfaction and Likelihood to Recommend
Access to Meaningful Information
Communication with Nurses
Communication with Physicians
Communication about Medications
Care Transitions
Discharge Instructions
Support and Participation of Family
Responsiveness
Discharge Instructions
Healing Environment
Cleanliness
Quiet at Night
Support for Body, Mind and Spirit
Responsiveness
Pain Management
Quiet at Night
Overall Satisfaction and Likelihood to Recommend
Making the Connection

18. © Planetree 2013
1) Partner with patients.
2) Create a physical environment that supports your culture.
3) Make data meaningful to staff.
4) Look beyond the hospital setting.
5) Put compassion first.
Patient-Centered Strategies for HCAHPS
Improvement

19. 1. Partner with Patients and Families
Patient Pathways
Shared Medical Records

20. 77.8%
69%
50%
60%
70%
80%
90%
Yes No
*Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)
Were you told you could read your medical chart?
Verysatisfiedwiththeiroverallhospitalexperience?
Patients who are told they could read their medical chart are more
likely to be very satisfied with their overall hospital experience
Impact of Shared Medical Record on Overall
Patient Satisfaction with Care

21. © Planetree 2013
“Reviewing the chart with someone put me
at ease.”

22. Bedside Shift Report

23. Bedside shift report drives patient satisfaction
82
84
86
88
90
92
94
96
Nurses treat you
with
courtesy/respect
Nurses attitude
toward requests
Attention to
special/personal
needs
Nurses kept you
infromed
Staff include you
in decision re:
treatment
Staff worked
together to care
for you
6 months prior to implementation of bedside report
6 months after implmentation of bedside report
Effects of bedside shift change at a Planetree Designated Hospital

24. Partnering with Patients…Beyond the Bedside
• Invite patients to serve on hospital committees and HCAHPS
improvement task forces
• Invite board members to round on patients prior to every board meeting
• Invite a patient to share his or her story (what went well, what didn’t
go well) to kick off every board meeting

25. 2. Create a physical environment that supports your culture
“Why is the hospital not as humanely practical in
aesthetic effect as it tries to be in physical support?”
Frank Lloyd Wright

26. © Planetree 2013
Poor Patient Experience = Post-Hospital Syndrome
CONTRIBUTING FACTORS:
• sleep deprivation
• disruption of normal circadian rhythms
• poor nourishment
• poorly controlled pain and discomfort
• medications that can alter cognition and physical function
• deconditioning due to bed rest or inactivity
Krumholz, HM. N Engl J Med 368:100 - 102 | January 10 , 2013

27. © Planetree 2013
Assess Your Healing Environment/Reduce Stressors
EMOTIONAL SUPPORT
• Family overnight accommodations
SLEEP SUPPORT
• Quiet Environment/Sleep Menus
NOURISHMENT
• Family Kitchens/Access to Food
CONNECTION TO NATURAL ENVIRONMENT
• Healing Gardens and Natural Light

28. © Planetree 2013
Innovations in the Healing Environment:
A Patient-Centered Quiet Campaign

29. More Evidence
The use of call lights by patients decreased by 40%
following implementation of decentralized nursing
stations & 24-hour visitation (Charmel, 2003)

30. 3. Make data
meaningful to
staff.
But remember, the data
are not the point,
patient experiences are
the point!
-

31. © Planetree 2013
Making Data Meaningful to Staff
Engage staff (and patients) in the selection of
quality measures
Involve staff in performance improvement efforts
 Give staff time to participate in improvement efforts
Display data so it is easy to read and standardized
Make staff aware of the data being measured
 Discuss in staff meetings
 Reinforce with postings and displays
Meredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.

32. © Planetree 2013
4. Look beyond the hospital setting

33. © Planetree 2013
New HCAHPS Domain: Care Transitions
Mandatory for patients discharged as of Jan. 2013:
• Question 1: The hospital staff took my preferences and those
of my family or caregiver into account in deciding what my
healthcare needs would be when I left the hospital.
• Question 2: When I left the hospital, I had a good
understanding of the things I was responsible for in managing
my health.
• Question 3: When I left the hospital, I clearly understood the
purpose for taking each of my medications.

34. © Planetree 2013
Patient-Centered Care Transitions
Hospital
Skilled
FacilityHome Health
Agency
Physician
Office
Patient
• Same Page Transitions
• Inter-Continuum Collaboratives
• Physician appointments made
prior to hospital discharge
• Discharge summary provided to
patient and PCP
• Personal Health Records
• Support for family caregivers

35. © Planetree 2013
5. Put compassion first.
“I felt like I was
interrupting them
when I asked a
question.”

36. Compassion in Action
VA New Jersey Sleep Menu
Good Samaritan
Hospital Patient
Story Board
Physician
communication
coaching
Patient Experience training and education for
staff- Middle Management Training

37. “[The doctor]
came in, pulled
up a chair and
said he wanted
to talk…and we
talked on my
terms.”

38. © Planetree 2013
Criteria can be downloaded at
www.planetree.org
A Measureable Framework for PCC Culture
Change and HCAHPS Improvement

39. Planetree Designated Hospitals and HCAHPS performance:
A marker of Quality:
Planetree Designated
Hospitals consistently
outperform the National
Average on HCAHPS since
public reporting of scores
began.

40. 69
70
71
72
73
74
75
76
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patient's Room and Bathroom Always Kept Clean
Designated Hospital Average National Average

41. 62
63
64
65
66
67
68
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Responsiveness
Designated Hospital Average National Average

42. Note: The difference is statistically significant (p<0.05).
80
81
82
83
84
85
86
87
88
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patients Given Information About Recovery At Home
Designated Hospital Average National Average

43. 56
57
58
59
60
61
62
63
64
65
66
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Staff Always Explained About Medicines
Designated Hospital Average National Average

44. 75
76
77
78
79
80
81
82
83
84
85
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Doctors Always Communicated Well
Designated Hospital Average National Average

45. Note: The difference is statistically significant (p<0.05).
74
75
76
77
78
79
80
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Nurses Always Communicated Well
Designated Hospital Average National Average

46. Note: The difference is statistically significant (p<0.05).
68
69
70
71
72
73
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Pain Was Always Well Controlled
Designated Hospital Average National Average

47. 55
56
57
58
59
60
61
62
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Patient's Room Always Kept Quiet At Night
Designated Hospital Average National Average

48. Note: The difference is statistically significant (p<0.05).
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Percent of Patients Highly Satisfied
(Overall Rating 9 or 10)
Designated Hospital Average National Average

49. Note: The difference is statistically significant (p<0.05).
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12
CMS Reporting Period
Would Definitely Recommend Hospital to Friends and Family
Designated Hospital Average National Average

50. The Bottom Line on VBP and Designation
A preliminary analysis indicates that, as a group, Patient-
Centered Designated Hospitals are poised to receive:
•127%in reimbursement revenue
•$770,000(100% of all withheld monies plus additional revenues)

51. © Planetree 2012© Planetree 2012
Resources For Your Journey
Patient-Centered Care
Improvement Guide
Patient-Centered
Hospital Designation
Criteria
HCAHPS Assessments

52. © Planetree 2012© Planetree 2012
Planetree
130 Division Street
Derby, CT 06418
www.planetree.org
203.732.1365
Michael Lepore, PhD
Director of Quality, Research, &
Evaluation
mlepore@planetree.org
Questions