Improving HCAHPS Scores Alone is Not the Answer: Hospitals Need a Patient-Centric Foundation

Hospital readmissions and patient satisfaction are two top-line items for hospital leaders today, as both affect patients' health and hospitals' reimbursement. Under the Hospital Readmissions Reduction Program, hospitals will see cuts to their Medicare payments if they have more readmissions than expected for certain conditions. Under the Hospital Value-Based Purchasing Program, Hospital Consumer Assessment of Healthcare Providers and Systems survey scores are a contributing factor in determining hospitals' payments.

Nell Buhlman is vice president of product strategy at Press Ganey.While a recent Press Ganey Associates report linked high patient satisfaction with low hospital readmission rates, hospitals should focus efforts on a strong patient-centric foundation that will improve all quality measures rather than limiting efforts to only increasing HCAHPS scores, according to Nell Buhlman, vice president of product strategy at Press Ganey.


The report, "The Relationship Between HCAHPS Performance and Readmission Penalties," found that hospitals with overall HCAHPS VBP scores of 0 to 19 were more likely to have higher than expected readmission rates and therefore received the highest readmission penalties — an average of 0.4 percent. In contrast, hospitals with HCAHPS scores of 80 to 100 were much less likely to have higher than expected readmission rates and therefore averaged penalties of just 0.1 percent. Despite this relationship between patient satisfaction and readmissions, it does not guarantee that increasing HCAHPS scores will automatically reduce readmissions, Ms. Buhlman says.

Patient-centric foundation

"One of the things that is really critical about the study — what we really want leadership to understand — is that it's the underlying patient-centric approach to care that facilitates desirable performance across the board," she says. "It's not the idea that improvement on HCAHPS will lead to low readmission rates; it's that a patient-centric approach will facilitate desirable scores on HCAHPS as well as desirable performance on readmissions."

While hospitals should still focus on improving patient satisfaction, an HCAHPS initiative without the support of a strong patient-centric foundation will not succeed in the long-term, according to Ms. Buhlman.

Putting the patient first
Fundamentally, a patient-centric approach is about understanding and meeting patients' needs. These needs span across clinical and non-clinical areas, such as emotional and psychological health. "In addition to a focus on the care for patients, [a patient-centric approach] is a focus that also includes minimizing stress and reducing anxiety; this can be really beneficial for patients to the extent that reducing stress and anxiety allows patients to be more engaged and informed in their care," Ms. Buhlman says.

Meeting both clinical and emotional needs of patients can improve both readmission rates and satisfaction. Ensuring patients receive high-quality care and understand their discharge instructions can prevent readmissions, while attending to patients' emotional needs can increase their satisfaction.

Communicate to engage patients
A patient-centric approach requires clear and consistent communication to patients and other healthcare providers. Ensuring providers are communicating effectively with patients engages patients in their care and can improve both readmission rates and HCAHPS scores. "You need to have an understanding about the types of communication that foster the engagement that organizations are looking for from patients," Ms. Buhlman says.

For example, communicating with patients about their medications repeatedly throughout the course of the inpatient stay — rather than just at discharge — can increase the likelihood patients will follow instructions and avoid a readmission. Explaining medications to patients can also make them feel more empowered and confident, which can increase satisfaction. In fact, communicating with patients about medication is an item on the HCAHPS survey.

By creating a strong base of quality care, hospitals can improve both patient satisfaction and readmission rates.

More Articles on Hospital Quality:

Study: Healthcare Quality, Cost Association Has Inconsistent Evidence
3 Simple Ways Hospitals Can Engage Patients in Their Care

Population Health Management is a Two-Way Street: Encouraging Patient Engagement

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