By Don Sadler
Organizations across all industries are placing a high priority on measuring patient satisfaction, and the health care industry is no different. Hospitals and ambulatory surgery centers (ASCs) are using a variety of tools to gather feedback from patients about their experiences and how well the hospital or ASC staff performed.
A Critical Performance Measure
“Patient satisfaction is an important measure of a health care organization’s performance, especially in today’s world where this information is publicly available,” says Erin Kyle, DNP, RN, CNOR, NEA-BC, editor in chief, Guidelines for Perioperative Practice with Association of periOperative Registered Nurses (AORN).
“It’s easy for patients to search for this information and use it when making decisions about where to seek health care,” adds Kyle. “We’re seeing in the literature that higher satisfaction scores are associated with better patient outcomes.”
There are several different ways that health care organizations can measure patient satisfaction. The main way is through the Consumer Assessment of Healthcare Providers and Systems survey, or CAHPS.
There are separate CAHPS surveys for hospitals and ASCs. The hospital survey is called the HCAHPS while the survey for ASCs and hospital outpatient departments (or HOPDs) is called the Outpatient and Ambulatory Surgery CAHPS, or the OAS CAHPS, survey.
According to Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services at Anmed Health, the HCAHPS scoring system helps hospitals and its governing bodies evaluate patient satisfaction through quantitative measurements.
“HCAHPS scores are used to enable objective comparisons of hospitals across a variety of metrics,” says Dennis. “They also inform health care consumers about the relative standard of care at each facility and create incentives for hospitals and health care organizations to compete on patient engagement and satisfaction.”
“All organizations should be accountable to their consumers, and health care organizations are no exception,” Dennis adds. “Patient satisfaction surveys are a means of quantifying patient-centered delivery of quality health care. They measure the effects of clinical outcomes, patient retention and medical malpractice claims and increase the referral base to the hospital or ASC.
History of the OAS CAHPS Survey
Development of the OAS CAHPS survey has been underway for the past decade. Before this, there was not a standardized survey instrument to assess patient experiences with the outpatient surgical care they received as ASCs and HOPDs.
A field test of the survey was conducted in 2014 to test the reliability of the survey items and implementation procedures and the survey instrument was revised and finalized. The survey then received accreditation in 2015.
In 2016 the Centers for Medicare & Medicaid Services (CMS) implemented a voluntary national reporting program for the OAS CAHPS survey that was open to any certified HOPD or ASC. CMS-approved survey vendors administer the survey on behalf of HOPDs and ASCs and submit the data to the OAS CAHPS Data Center.
OAS CAHPS survey participation will remain voluntary through 2023 but it will be linked to Medicare reimbursement starting in 2024 for HOPDs and 2025 for ASCs.
The OAS CAHPS survey includes questions about the following types of patient experiences:
- The level of communication and quality of care provided by health care practitioners and office staff.
- The patient’s preparation for the surgery or procedure.
- The patient’s preparation for discharge and recovery.
According to the OAS CAHPS website, the survey was designed to produce comparable data on the patient’s perspective that allows objective and meaningful comparisons between HOPDs and ASCs on domains that are important to consumers. This will allow consumers to make more informed choices when choosing a HOPD or ASC.
The website lists a number of potential benefits to participating in the OAS CAHPS national reporting program, including the following:
Helping provide valuable information to consumers about the quality of care provided nationally by HOPDs and ASCs.
Comparing patient responses against state and national averages, which will be available for download.
Meeting state or other regulations that require a patient satisfaction survey to be conducted regularly.
HOPDs and ASCs can choose to add supplementary questions to the OAS CAHPS survey, as well as replace their internal patient experience of care surveys with the OAS CAHPS survey, notes the website.
The Ambulatory Surgery Center Association (ASCA) supports quality reporting.
“ASCA has long encouraged CMS to implement a quality reporting program for ASCs and hospital outpatient departments that would enable patients to make meaningful comparisons among providers,” says ASCA Chief Executive Officer William Prentice.
“The OAS CAHPS survey could be a step in the right direction,” Prentice adds, “but only if certain changes that would encourage patient participation and reduce the administrative and financial burdens on our facilities can be made.”
Preparing for the OAS CAHPS Survey
While it might seem a long way off, it’s not too soon to start preparing for how your organization will begin participating in the OAS CAHPS survey when it is linked to Medicare reimbursement in 2024 and 2025.
It starts with researching and interviewing the approved survey vendors, says Bev Kirchner, BSN, RN, CNOR, CNAMB, corporate compliance officer at SurgeryDirect.
“This process could take six to eight weeks to find the right fit for your organization,” she says.
Once you have selected a survey vendor, the next step is to negotiate a contract and begin setting up your organization for success.
“Don’t forget to educate your staff,” adds Kirchner. “Also make sure you and your staff understand the language and terms being used so you can incorporate the terms into your patient communication without telling the patient what will be on the survey. I’ve heard from several early adopters that the terms confuse the patient so initial scores may be low due to the terms used and the patient’s lack of understanding.”
Kirchner also stresses the importance of reviewing the requirement of the quality indicator and educating staff about it.
“Prepare your quality assurance and performance improvement (QAPI) plan to include the indicator and make sure your policies and procedures cover the indicator,” she says. “Start early and work out the problems before the reporting period starts.”
A Second Set of Eyes
Kirchner has been actively involved recently in helping ASCs improve patient satisfaction.
“Patients are our second set of eyes,” she says. “Along with their family members, they perceive things differently – they see and hear things we miss. With their input, we can improve our communication skills and better understand how to meet our patients’ needs.”
“This is especially important in an ASC because we send patients home within a few hours after surgery,” Kirchner adds. “Our communication must be clear and the education must be delivered in a format the patient learns best.”
Kyle points to research demonstrating a link between patient satisfaction and quality outcomes.
In a 2020 study, researchers evaluated 327 cardiac patients who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process was associated with fewer readmissions at 90 days post-discharge.
“Higher patient satisfaction with overall assessment of care and hospitalization correlated with a lower mortality rate at six months post-discharge,” says Kyle. “In this population, higher patient satisfaction correlated with better patient outcomes. Health care organizations can use patient satisfaction data to inform areas for health system improvement.”
And in a 2017 study, researchers evaluated the relationship between patient satisfaction and outcomes for 373,692 patients who underwent major cancer surgery.
“In both unadjusted and adjusted analyses, hospitals with higher proportions of patients reporting excellent satisfaction had lower complication rates, readmissions, mortality and prolonged length of stay,” says Kyle.
“When patients form positive relationships and begin to trust their providers, they become more engaged in their own care,” says Dennis. “Great patient experiences often lead to more satisfied patients who tend to comply with treatment and follow recommendations better than dissatisfied patients.”
Higher patient satisfaction also translates into lower malpractice risks.
“And a better patient experience gives hospitals a competitive advantage,” says Dennis.
The higher a hospital’s HCAHPS scores, the higher their reimbursements will be, and vice versa, Dennis adds. “Low HCAHPS scores not only affect a hospital’s reputation, but they also decrease monies received from Medicare.”
There will always be that one patient who you can’t please no matter what you do, notes Kirchner.
“But don’t worry about this,” she says. “Instead, be prepared to address the majority’s needs. And you will find the majority will respond to care positively.”
And remember that reality is not always what the patient satisfaction survey measures. “Instead, it measures patient perception, which is the patient’s reality,” says Kirchner.
Improving Patient Satisfaction Scores
To improve patient satisfaction scores, Kirchner recommends analyzing the data, reading the patient comments and doing research based on them. “Then, develop a performance improvement project to make changes that will improve your scores and meet the patients’ needs,” she says.
“The very best strategy to achieve top marks in patient satisfaction is to focus all of your efforts on excellent outcomes by using evidence-based practices for care delivery,” says Kyle. “And remember that patients are more satisfied when they experience a safe environment of care, have good outcomes and are encouraged to participate in their care.”
“Patients who witness inefficiencies, a hostile work environment among health care personnel or are not included in their care are likely to be the same patients who have lower satisfaction scores,” Kyle adds.
Dennis lists the following suggestions for improving patient satisfaction scores:
Develop a rapport with your patients
- Make it personal and not just about the patient’s condition
- Set expectations for your staff and hold them accountable for achieving them
- Listen carefully to your patients
- Improve patient-provider communication
- Improve the physical hospital or ASC environment
- Be attentive and strive to reduce unnecessary pain and discomfort
“High patient satisfaction scores tell me how well a health care organization’s processes are working,” says Kirchner. “They help organizations meet the value-based care benchmarks and thus will become essential when it comes to Medicare reimbursement and negotiating third-party payor contracts.”
Regardless of the environment, patient care is driven by outcomes.
“If you track patient outcomes and show data that your patients receive the best care using the best processes, your organization will survive today and in the future,” says Kirchner. “If your outcomes are poor, however, you will lose physicians and patients.”
Kirchner believes that going forward, health care will be driven by three main things: compliance, quality and safety.
“These are the future drivers of health care success,” she says. “If you don’t focus on these three aspects of care, you will not thrive in the future.”