Instructions
Take Another Course
|
Standards of Care: Patient Perspective Now let’s discuss customer expectations as they relate to standards of care.
First, let’s consider that we are facing a deep and demanding consumerism that is now challenging traditional healthcare. An example many of you may be able to relate to include Amazon’s introduction of “unparalleled choice and unbridled immediacy” at our fingertips. Recommendations for those in health care systems suggest that treating patients as customers, whose loyalty depends on how happy they are with their care. The standards of care developed for various conditions are designed to provide the best outcomes at the lowest cost and not coincidently, are designed to do so while maximizing the patient’s perceptions of that care. Thus, a better understanding of what makes our customers happy is an important dimension in the application of standards of care.
Satisfaction surveys are widely used in the U.S. to rate everything from dining experiences to various tradesman to online banking. Healthcare has been relying on satisfaction measures as a way to guide them through the process of increasing their quality of care delivered, as well as making sure that those providers participating in value-based payment models are scoring high enough to receive bonus payments at the end of the year.
In the United States patient satisfaction has been called “The Indispensable Outcome.” And now that CMS has made patient satisfaction (or the patient experience of care) a key marker of the value they want to measure, it has gained a key position in the spotlight. Patient satisfaction surveys, when developed and interpreted correctly, can also lead to developing a better methodology for understanding how consumers perceive care. Which may be the key to patient satisfaction as a whole.
Patient satisfaction surveys are the main qualitative measure from the patient’s perspective. Most patients will not have the ability to judge a physician’s care from a clinical perspective, nor are they often able to judge the cost-effectiveness of that care (they might know if their costs are high or low, but they do not having anything to compare costs to), so they often judge the quality of care received based on the physician’s concern and demeanor. As a result, patient satisfaction surveys are viewed as a somewhat controversial measure of quality care.
Proponents of patient surveys point out that they can provide feedback to physicians to assist them in improving their practice. In addition, patient satisfaction often correlates with patient involvement in decision making and can improve patient-centered care. The patient’s evaluation of care can identify opportunities for improvement in care, and provide a comparison across health care institutions. Opponents of patient satisfaction surveys argue that the data is often not reliable, that the expense of the surveys does not justify their costs, and that what is measured (mainly how the patient “felt” about their provider) is not a good indicator of quality.
Still, hospital administrators from facilities participating in value-based purchasing agreements are acutely aware that they are being graded according to their patient’s perceptions of their facilities’ care--and that these grades can make the difference between the hospital turning a profit or incurring a loss.
Helping health care consumers make choices are some patient satisfaction survey results posted on the web.
Results from Medicare’s mandatory HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) (pronounced H-Caps), a comprehensive patient satisfaction survey developed by Medicare, are posted on the CMS Hospital Compare (hospitalcompare.hhs.gov) website along with other hospital performance measures. This places an extra level of importance on patient satisfaction scores. HCAHPS was initiated in 2006 utilizing many of these performance and measurement criteria.
The Department of Health and Human Services bases 30 percent of hospitals' Medicare reimbursement on patient satisfaction survey scores from the HCAHPS. In 2017, Medicare withheld 2% of total reimbursements—approximately $1.7 billion—from hospitals. The only way to earn that money back was by scoring well on their patient satisfaction surveys, and to meet a few other basic care standards. Top performers were eligible to earn bonuses from this pool.
As a general rule, hospitals and health plans adhere to the Medicare HCAHPS survey measures first developed in 2006, which in turn owe their existence to SERVQUAL’s (short for service quality) five measures, which were developed in their earliest forms in the late 1980’s. These measures are designed to explore the gap between customer expectations and experience. The five measures are: Reliability, Assurance, Tangibles, Empathy, and Responsiveness. Reliability has 5 questions and rates the ability to perform the promised service dependably and accurately. Assurance has 4 questions and rates the knowledge and courtesy of employees and their ability to convey trust and confidence. Tangibles has 4 questions and rates the appearance of physical facilities, equipment, personnel and communication materials. Empathy has 5 questions and rates the provision of caring, individualized attention to customer. Responsiveness has 4 questions and rates the willingness to help customers and to provide prompt service.
As you can see, the bottom line and results for using evidence and experience-based standards of care aims to provide the best possible outcomes and the lowest price while maximizing patient perceptions of their care. |
.h4.jpg)
