Patient experience and quality impacts on reimbursement: 5 things to know

As hospital and health system reimbursements become more closely tied to clinical outcomes as well as patient satisfaction, patient experience surveys are becoming an increasingly valuable tool for healthcare organizations to guide efforts for improving the patient experience.

At the 12th Annual Healthcare and Life Sciences Private Equity & Finance Conference, hosted by McGuireWoods and McGaldrey in Chicago on Tuesday, Barry Straube, MD, director of The Marwood Group, and Joe Greskoviak, president and COO of Press Ganey, discussed how patient satisfaction surveys are tied to reimbursement and how they can be used strategically to enhance organizations' marketability.

Here are five key takeaways from Dr. Straube and Mr. Greskoviak's discussion.

1. In 1995, CMS developed Consumer Assessment of Healthcare Providers & Systems surveys. Since then, the annual surveys have been expanded to assess patients' experiences with healthcare providers and plans, including hospitals, home healthcare agencies, physicians and health and drug plans, among others. CMS plans to expand the surveys and link performance to reimbursement more in the future, according to Dr. Straube.

2. "As a health system, compliance with CAHPS is table-stakes these days," Mr. Greskoviak said. The government mandates all hospitals and health systems to assess for quality and patient satisfaction, and applies reimbursement penalties to organizations that fail to meet certain expectations. With a national database of patient experience scores available, hospitals have the ability — and the responsibility — to compare themselves to similar organizations and pinpoint areas in need of improvement, Mr. Greskoviak explained.

3. The patient experience is directly associated with an organization's brand reputation and ability to capitalize on market share.

"We are seeing a shift in the way organizations look at the engagement of their patient populations. The ability to use patient experience as a competitive and strategic differentiator to gain market share is a valuable tool," Mr. Greskoviak said.

Leading organizations that engage their patient populations are the ones making the biggest gains, he explained. Administering and using the results of patient satisfaction surveys, such as CAHPS and those by Press Ganey, to improve the patient experience can solidify loyalty among current patients and improve reputation among prospective ones.

4. According to Mr. Greskoviak, there is quantifiable evidence that measuring quality outcomes and patient experience leads to quality improvement.

"The top performers from the patient experience perspective have the lowest avoidable readmissions," he said. "Shining the light on something makes it better."

In addition to low readmission rates, organizations that perform well on patient experience surveys have better adherence with post-discharge guidelines for patients and less utilization of unnecessary healthcare services, Dr. Straube added.

5. Finally, by giving patients a voice in their healthcare, hospitals and systems can take steps to make the patient experience more tolerable for patients, more effective and less expensive.

"There are two kinds of suffering in healthcare," Mr. Greskoviak said. "Unavoidable and avoidable suffering. Unfortunately, there is a tremendous amount of avoidable suffering, and this is a symptom of the dysfunction of our healthcare system."

Patient experience surveys, in addition to keeping organizations accountable, afford hospitals the chance to act on their promise to offer patient-centered care by offering patients a voice. According to Mr. Greskoviak, patients don't necessarily seek to be "satisfied" by their care when in a hospital. Rather, they have three basic expectations they seek hospitals to meet: Don't harm me, have empathy and don't bankrupt me.

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