Medical Practice Patient Experience Overview - Amazon S3 · Medical Practice Patient Experience...
Transcript of Medical Practice Patient Experience Overview - Amazon S3 · Medical Practice Patient Experience...
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Medical Practice Patient
Experience Overview
Matthew Bates, MPH
Managing Director
CG CAHPS
Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization
Charles A. Stanley, M.D.Pediatric Endocrinologist
Chief, Division of Endocrinology/Diabetes
C Everett Koop, M.D.Pediatric Surgeon
Former US Surgeon General
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• Congenital Hyperinsulinism (HI), the secretion of insulin is not properly regulated, causing excess
insulin secretion and low blood sugar. Blood sugars can drop rapidly (20+ pts in <15 mins). Prolonged
or severe low blood sugar can cause seizures or permanent brain damage. Treated with Diazoxide
and/or removal of majority of the pancreas.
• Rare disease. NIH estimates 1 in 50,000 births (~75 cases per year in US today)
– In the 1970s, most children died before age 18 and many that survived suffered brain damage
• Only 1 specialized treatment center in the US (CHOP) and 3 in the world.
My Brother My Niece & her dog Sage
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Healthcare Flywheel®
4
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“Cure sometimes, treat often,
comfort always”-Hippocrates, born 460 BC
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Three Dimensions of QualityPatient Experience, Clinical Safety and Effectiveness
“The data presented display that patient experience is positively associated
with clinical effectiveness and patient safety, and support the case for the
inclusion of patient experience as one of the central pillars of quality in
healthcare.”
“It supports the argument that the three dimensions of quality should be looked
at as a group and not in isolation.”
“Clinicians should resist sidelining patient experience as too subjective or mood-
oriented, divorced from the ‘real’ clinical work of measuring safety and
effectiveness.”
Source: A systematic review of evidence on the links between patient experience and clinical safety and effectiveness; BMJ Open, 2013
Studies
Positive
Associations
No
Association
Negative
Association
557 429 (77.8%) 127 (22%) 1 (0.2%)
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Patient Experience is Positively Correlated
with Patient Engagement and Adherence
Communication & Medication Refill Adherence
•9,377 diabetic patients
•…30% of participants had poor cardiometabolic
medication refill adherence. The prevalence of poor
adherence increased by 0.9% (P = 0.01) for each 10-
point decrease in CAHPS score.
Source: JAMA Internal Medicine 2013; 173 (3): 210-218
Additional medication adherence studies: DiMatteo, 1994; DiMatteo MR, 1993; Safran DG, 1998
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The Quadruple Aim
8
Experience
of Care
Per Capita
Costs
Population
Health
Caregiver
Well-BeingReferences:
• Annals of Family Medicine, November/December 2014vol. 12 no. 6 573-576
• BMJ Quality & Safety, doi:10.1136/bmjqs-2015-004160
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NCQA: State of Healthcare Quality
“How patients feel—both in terms of their
symptoms and in terms of their care—is central to
medicine’s mission as a helping profession.”
“... patients with better experiences have better
health outcomes.”
Source: Improving Quality and Patient Experience: The State of Health Care Quality 2013, NCQA, October 2013.
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“Patients First” is the guiding principle of Cleveland Clinic. We
strive to provide outstanding and compassionate care and
service, every step along the way.
Geisinger Health System is committed to providing you and
your family with the best possible patient experience, each
and every time you visit us.
Our goal is to provide exceptional care and service to you and
your family. --Kaiser Permanente
The Needs of the Patient Come First --Mayo Clinic
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QualityTo provide a level of patient care and
service good enough for our own mothers,
without the need for special arrangements
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We Attract & Retain Patients…
with Remarkable Patient Experience
No Margin, No Mission
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Do you want high patient experience or
high productivity? I can’t do both!
Source: Perm J 2012 Fall; “Patient Experience and Physician Productivity: Debunking the Mythical Divide at HealthPartners Clinics”
There are many physicians with high
productivity and high patient experience!
Low Productivity
High Experience
Low Productivity
Low ExperienceHigh Productivity
Low Experience
High Productivity
High Experience
Pa
tie
nt
Ex
pe
rie
nc
e
Provider Productivity
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Physician Compare Example
Source: ttps://www.medicare.gov/physiciancompare/
SUTTER GOULD MEDICAL FOUNDATION
Top Box or
% Always
CG CAHPS
Domains
STARS (Relative
Percentile Rank
compared to others)
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State / Public Example
Source: www.mnhealthscores.org
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CMS and other payers are leveraging Patient Experience (CAHPS)
surveys to drive two priorities:
Quality (VBP)
Transparency
17
WHY Patient Experience (CAHPS) Surveys?
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“Could a greater
miracle take
place than for us
to look through
each other's eyes
for an instant?”
Henry David Thoreau1817-1862
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CG = Clinician and Group–Its about your whole team
CAHPS = Consumer Assessment of
Healthcare Providers and Systems–Its about the patient’s experience
Note: CG CAHPS = CG-CAHPS = CGCAHPS
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CG CAHPS Family Tree (10 and counting…)
CG CAHPS
CG CAHPS
6-Month
Longitudinal CG CAHPS Visit
Adult Child
PCMH
12-Month
CMS
6-Month
Adult Child Adult Child ACO PQRS
9 12
Source: AHRQ v2.0 & v3.0 CG-CAHPS, CMS and NCQA
MA-PDP CAHPSOAS CAHPS
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Common “Payer Requested” Surveys for 2016
•CAHPS for PCMH– NCAQ Optional for Patient Certified Medical Homes (PCMH)
– 60% of US hospitals/health systems have or are working to create a PCMH*
•CAHPS for PQRS– CMS Required for Groups of 100+ EPs
– CMS Optional for Groups of 2-99 EPs
– 99% of US hospitals/health systems physician groups are participating in PQRS*
•CAHPS for ACOs– CMS Required for groups participating in CMS ACO programs
– 58% of US hospitals/health systems have created or are creating an ACO*
*Source: American Hospital Association (AHA), 2014 Survey of Care Systems and Payment
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CG CAHPS Surveys
CG CAHPS
Core
Questions
CG CAHPS Supplemental
Questions
CG CAHPS
Surveys
Examples:
• CAHPS for PQRS
• CAHPS for ACOs
• CAHPS for PCMH
Source: CG CAHPS longitudinal surveys from AHRQ
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So …… what’s at the core?
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CG CAHPS Survey (Version 3)13 scored questions grouped in 5 domains
Access to Care
• Patient got appointment for urgent care as
soon as needed
• Patient got appointment for non-urgent
care as soon as needed
• Patient got answer to medical question the
same day he/she contacted provider’s
office
Overall Rating of the Provider
• Overall rating of your Provider (0 to 10)
Provider Communication
• Provider explained things in a way that was
easy to understand
• Provider listened carefully to patient
• Provider showed respect for what patient
had to say
• Provider spent enough time with patient
Courteous and Helpful Office Staff
• Clerks and receptionists helpful
• Clerks and receptionists courteous and
respectful
Care Coordination
• Provider knew important information about
patient’s medical history
• Someone from provider’s office followed up
with patient to give results of blood test, x-
ray, or other test
• Someone from provider’s office talked about
all prescription medications being taken
Source: AHRQ, CG CAHPS Survey version 3
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Patient Experience is about High Reliability
There are 4 standardized answers to the core CG CAHPS questions
Always
Usually
Sometimes
Never
Only “Always” Counts
Top Box = Percent Always
Source: CG CAHPS 3.0 longitudinal survey; standardized answers
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Response Scale: Never, Sometimes, Usually, Always; Top Box = Always
1. Patient got appointment for urgent care as soon as
needed?
2. Patient got appointment for non-urgent care as soon
as needed?
3. Patient got answer to medical question the same day
he/she contacted provider’s office?
Access to Care
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Response Scale: Never, Sometimes, Usually, Always; Top Box = Always
1. Provider explained things in a way that was easy to
understand
2. Provider listened carefully to patient
3. Provider showed respect for what patient had to say
4. Provider spent enough time with patient
Provider Communication
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Response Scale: Never, Sometimes, Usually, Always; Top Box = Always
1. Clerks and receptionists helpful
2. Clerks and receptionists courteous and respectful
Courteous and Helpful Office Staff
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Response Scale: Never, Sometimes, Usually, Always; Top Box = Always
1. Provider knew important information about patient’s
medical history
2. Someone from provider’s office followed up with
patient to give results of blood test, x-ray, or other
test
3. Someone from provider’s office talked about all
prescription medications being taken
Care Coordination
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Overall Provider Rating Question
Only responses of 9 & 10
count as Top Box
0
8
3
1
7654
9
2
10 Best
Worst
Question:
Using any number from 0 to
10, where 0 is the worst
provider possible and 10 is the
best provider possible, what
number would you use to rate
this provider?
Source: CG CAHPS v2.0 & v3.0 longitudinal survey
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Studer Group’s CG CAHPS RecommendationsSkate to where the puck is going to be…
• If you haven’t started yet, start
conducting CG CAHPS surveys
ASAP
• Follow the $ and focus on
Longitudinal Surveys (ver. 2 or 3)
• Start by focusing on the “Core
Questions” that every CG
CAHPS survey contains
• Focus on improving your “top
box results” vs. vendor
benchmarks
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They may not remember
what you said…
They may not remember
what you did…
They always remember how
you made them feel.
-Maya Angelou
Connecting at a "gut level"
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Matthew Bates, MPH
Managing Director
720-355-1053 (mobile)
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