Excellence in patient satisfaction within a patient-centered culture.

Many healthcare leaders are anticipating the Centers for Medicare & Medicaid Services' (CMS) value-based purchasing (VBP) program, in which payments are based partially on patient satisfaction. To qualify for incentive payouts, hospital executives need to look intently at ways to boost HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores. A patient-centered culture can help facilitate improvements in HCAHPS scores.

VBP AND HCAHPS

Hospital VBP links a portion of hospitals' Inpatient Prospective Payment System payment from CMS to performance on a set of quality measures. The Hospital VBP program was established by the Affordable Care Act of 2010. Many final rules issued in 2011 outline the parameters of the program for fiscal years 2013 and 2014 (CMS 2012). CMS (2012) clarifies:

   The total performance score for hospital VBP in FY 2013 will have
   two components: the clinical process domain, which accounts for 70%
   of the total performance score; and the patient experience domain,
   which accounts for 30% of the total performance score. The HCAHPS
   survey is the basis for the patient experience domain.

The HCAHPS survey was the first national, standardized, publicly reported survey of patients' perspectives of hospital care. The survey is designed to produce data about patients' views about care that allow objective, meaningful comparisons of hospitals in areas of importance to consumers. Additionally, public reporting of the results incentivizes hospitals to improve quality of care and enhances accountability in healthcare by increasing transparency (CMS 2010).

In summary, VBP provides financial incentives for hospitals that meet certain quality performance standards--including measures that focus on patient perceptions of care. That such measures are included further solidifies the economic significance of providing excellent care. These incentives are anticipated to compel more healthcare leaders to champion the importance of providing patient-centered care.

PATIENT SATISFACTION IN A PATIENT-CENTERED CULTURE

Under VBP, it will be more important for hospitals to pay attention to patient satisfaction and the overall patient experience. The program is likely to fuel further interest in patient-centered approaches to care. Patient-centered hospitals look to patients to help define a positive and satisfying patient experience. HCAHPS scores can show hospitals how well they are meeting patients' needs and can call attention to opportunities for improvement (Frampton et al. 2008).

Planetree Designated Patient-Centered Hospitals represent the highest level of achievement in patient-centered care based on evidence and standards, and the Planetree Designation Program is the only known program to formally recognize excellence in patient-centered care across the continuum of care (Planetree 2012). Demonstrating the positive association between patient-centered care and patient satisfaction, Planetree Designated Patient-Centered Hospitals consistently exceed national HCAHPS performance benchmarks for patient satisfaction (see Exhibit 1). These hospitals as a group perform better than the CMS national average in all ten of the publicly reported HCAHPS categories, most significantly in overall rating and questions about willingness to recommend (Frampton and Charmel 2009).

CASE IN POINT AT WINDBER MEDICAL CENTER

Windber Medical Center (WMC), a 54-bed hospital in western Pennsylvania, is a Planetree Designated Patient-Centered Hospital. We are the only Planetree hospital in Pennsylvania and one of only 13 hospitals in the country to have achieved Planetree Designation status. We have demonstrated a strong association between patient-centered care and excellence in patient satisfaction. Our HCAHPS scores consistently exceed national, state, and regional averages. In fact, WMC was the recipient of the HealthGrades Outstanding Patient Experience Award for 2011, placing us within the top 10 percent of hospitals nationwide for exemplary service to patients (HealthGrades 2012).

THE FINANCIAL BENEFIT OF PATIENT SATISFACTION

Improvements in patient satisfaction can also contribute to positive financial results (Hall 2008). Increased patient loyalty is associated with revenue gains and enhanced reputation is associated with increased patient volumes and profits, reduction in malpractice claims, and greater efficiency (Hall 2008). In addition, "hospitals with high performance scores in patient care are more profitable" (Press Ganey 2011). US hospitals within the top 25 percent of HCAHPS scores are, on average, the most profitable and have the best clinical outcomes (Press Ganey 2011), suggesting that a great patient experience coupled with superior clinical outcomes can result in stronger financial performance as well.

FUTURE SIGNIFICANCE

Excellence in patient satisfaction within a patient-centered culture can result in improved outcomes. Healthcare leaders need to recognize the importance of exemplary care that is truly patient centered and should listen to the voice of the patient. Institutions that endeavor to seek and respond to consumer expectations and preferences will be distinctly poised to reap the benefits of patient satisfaction, improved quality of care, and greater reimbursement (Frampton and Charmel 2009). With the pending launch of VBP, the benefits of patient-centered care bear unprecedented significance.

REFERENCES

Centers for Medicare & Medicaid Services (CMS). 2012. "HCAHPS Executive Insight." Published January 2012. www.hcahpsonline.org/executive insight.

--. 2010. "HCAHPS Fact Sheet." Published July 2010. www.hcahpsonline.org/files/HCAHPS Fact Sheet 2010.pdf.

Commonwealth Fund. 2012. "Why Not the Best?" Accessed March 9, 2012. www.whynotthe best.org.

Frampton, S., and P. Charmel (eds.). 2009. Putting Patients First: Best Practices in Patient-Centered Care, 2nd ed. San Francisco: Jossey-Bass.

Frampton, S., S. Guastello, C. Brady, M. Hale, S. Horowitz, S. Bennett Smith, and S. Stone. 2008. Patient-Centered Care Improvement Guide. Derby, CT: Planetree. www.patient-centeredcare.org.

Hall, M. F. 2008. "Looking to Improve Financial Results? Start by Listening to Patients." Healthcare Financial Management 62 (10): 76-80.

HealthGrades. 2012. "Quality Awards and Ratings." Accessed February 18. www.healthgrades.com.

Planetree. 2012. "What Is Planetree Designation?" Accessed February 18. http://planetree.org/?page id=89.

Press Ganey. 2011. "Press Ganey's 2011 Pulse Report Provides Broad Look at Key Trends in Health Care." Published November 14. www.pressganey.com/pressroom/pressroom_2011/11-11-14/ Good Patient_Care_Equals_Good_Business_%E2%80%93_New_Report-Shows-Higher -Performing_Hospitals_Earn_More_Profits.aspx.

Barbara Cliff, RN PhD, FACHE, President/CEO, Windber Medical Center

EXHIBIT 1
HCAHPS Comparison of US Planetree Designated Hospital Average and
CMS National Average Reporting Time Period: 04/01/2010-03/31/2011

                               Designated Hospital     CMS National
                                     Average              Average
Nurse Communication *                  80                   74
Doctor Communication *                 81                   78
Responsiveness *                       67                   60
Pain Management *                      72                   68
Medication Communication *             65                   59
Cleanliness *                          75                   68
Quiet at Night *                       60                   54
Discharge Information *                86                   82
Overall Rating (9 or 10) *             76                   67
Likelihood to Recommend *              79                   70

* Planetree performance is significantly better than the national
average at the 95% confidence level

Source: Commonwealth Fund (2012)