Meet the new addition to the CAHPS Family (part 1)

The Patient Protection and Affordable Care Act of 2010 has significantly altered the American healthcare system in multiple aspects. Under the ACA, the congress authorized Centers for Medicare and Medicaid Services (CMS), the largest single-mayor in the US, to accelerate the Value-Based Purchasing (VBP) initiative to be a major component of hospital payment system. The ACA also mandated a public reporting programs that incorporate information collected using the Consumer Assessments of Healthcare Providers and Systems (CAHPS?) surveys. i believe these actions are reflective of shifting US priorities in healthcare emphasizing the greater importance of patient-centered outcomes. CMS bases the incentive payments based hospital performance on a set of measures grouped into four domains. These domains vary by year and for 2017 these include: Patient and Caregiver-Centered Experience of care (25%), Safety (20%), Clinical care (30%) and efficiency and cost reduction (25%). Acute care Hospitals subject to the Inpatient Prospective Payment System (IPPS) must collect and submit HCAHPS data in order to receive their full annual VBP updates. As of 2017, patient experience accounts for 20% of the VBP, and is assessed by the sum of a hospital’s CAPHS (HCAHPS) base score and that hospital’s HCAHPS Consistency score. CAHPS Clinician & Group Survey (CG-CAHPS) data is be reported on the Physician Compare website and survey data indicate that a significant number of Americans consult online rankings or reviews of doctors or other clinicians in the prior year and 1 in 7 consulted online rankings or reviews of hospitals or medical facilities (Fox & Duggan, 2013). In addition, CMS now publishes HCAHPS Star Ratings to the Hospital Compare Web site. CMS indicates that “Star Ratings make it easier for consumers to use the information on the Compare Web sites and spotlight excellence in healthcare quality. Twelve HCAHPS Star Ratings will appear on Hospital Compare: one for each of the 11 publicly reported HCAHPS measures, plus an HCAHPS Summary Star Rating”.

Why should readers of this blog be concerned with regard to the CAPHS scoring systems? The answer is fundamental on multiple levels. First, while inconclusive, most studies have found strong correlation between patient satisfaction and better surgical outcomes; Second, the recent introduction of Merit-based Incentive Payment System (MIPS) now ties physician pay directly to patient experience scores; and lastly most anesthesia group have financial arrangements with hospitals and as a result have a strong financial incentive to assist hospitals to improve their CMS reimbursement that is partially based on HCAHPS scores. Finally, recently CMS has introduced the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS), which has a direct relevance to the work of anesthesiologists in ambulatory surgical care settings. The OAS CAHPS is scheduled to go live on January of 2018. If you want to learn more about patient experience please join us in the next Perioperative Care Boot Camp where Dr. James of the Studer Group will review the principles behind this construct. Our first two events were sold out so don’t wait for the last minute (periopmed.org).