About A. Woodward & Associates Our company’s primary focus is to create a more humane healthcare system by helping clients develop healthy patient and staff relationships. Our consulting services are customized to your organization, and your specific needs. Areas of expertise include service excellence, the patient experience and employee morale and engagement. A. Woodward & Associates was established in 1999 by Anita B. Woodward, MBA, FACHE. We have clients in all parts of the country. Anita has over 25 years of healthcare management, service excellence, and human resource experience, and her associates have a variety of complementary skills and experiences.
April 2010 Newsletter
HCAHPS: Improve Your Scores and Your Bottom Line Did you know?: Your hospital will be paid more or less, based on your HCAHPS patient survey scores? The difference could be hundreds of thousands of dollars, or even more, depending on the number of Medicare patients discharged from your hospital each year? Every item on the HCAHPS survey, not just the overall satisfaction question, may be used to determine hospital payments? You may no longer ask patients any of the survey questions any time before they receive the HCAPHS survey, including while they are in your hospital or during discharge phone calls? You may no longer encourage patients to give you good scores on the survey? The government is expanding the types of care for which patients receive surveys, and this process may well repeat itself for ER and outpatients? This article will give an overview of what is happening with HCAHPS, how it might affect your bottom line, and will give some quick tips to get you started on improving your patients' experiences, so you can be sure your hospital receives all possible funds from the government. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient surveys are being used in virtually all acute care hospitals in this country, since the Centers for Medicare and Medicaid Services (CMS) require them for hospitals to receive all possible funding from the federal government. Medicare patients typically are a large percentage of any hospital’s patient population, so receiving maximum reimbursement is critical to the bottom line. According to Bonnie Lowry of Healthstream Research speaking during a recent webinar provided by the Society for Healthcare Consumer Advocacy, it is now clear that CMS will begin "Value Based Purchasing" (VBP) based on HCAHPS survey scores, possibly as early as next year, but almost certainly by 2012. And it seems as though the 2010 survey data is what will be used to determine hospital payments in the first year of VBP. While details are not final, hospitals with better survey scores will receive higher funding levels from CMS. It appears that from 2-5% of a hospital's payments will be at risk in the VBP plan. Of that, 30% will be based on HCAHPS scores. (70% will be based on clinical quality measures.) Hospitals will receive points based on both their actual scores compared to national averages and benchmarks, and based on improvements to their scores from previous survey periods. It is probably worthwhile to calculate how much money this can represent for your hospital, as the amount may be quite significant. While many believed that it would be the overall satisfaction or likelihood to recommend questions that were used to determine the hospitals' payments, it now seems that each question will be given equal weight, so every aspect of the patient's experience that is surveyed will be equally important. In the past, many hospitals have both told patients about the survey, and encouraged patients to give the hospital good scores, or they have pre-surveyed the patients to try and get an idea of how the patient was evaluating their stay concurrently or shortly after discharge. In 2009, CMS issued new regulations (HCAHPS Bulletin #2009-01, Revised) prohibiting that behavior. Thus hospitals which were using the information to improve care must find other ways to assure their patients are satisfied. At A. Woodward & Associates, we have worked with many hospitals wanting to "improve our scores." There are literally thousands of ways to do this, and we are happy to talk with any of our readers about their specific circumstances. The following ideas are general enough that they should help most anyone. While they may seem like common sense, they are not, in our experience, common practice. Following any of these tips should help you, and should jumpstart your organization so that you begin to uncover those thousands of additional ways to "improve your score." First, we offer two guidelines on which our tips are based. Don't focus on your scores. That's right. Focus instead on making the patient's experience a great one, on creating a culture of service and your scores will take care of themselves. Remember every human being wants to be seen as a human being, as an individual, and to be cared about on that human level. Help every employee to see how their behaviors contribute to or detract from helping the patient feel that they are seen and valued. This does not come just from a script that "we value your business and thank you for choosing us," but rather from all the small and large ways we interact with the patient. Tip #1 – Make hourly nursing rounds on patients. Have nurses actually talk to patients during those rounds, unless the patient is sleeping. This will help contribute to patients feeling they are treated with courtesy and respect, we are responsive to their needs, and we care about any pain they have (if we ask.) All those items are survey questions. Tip #2 – When you have any encounters with patients or families, make eye contact with them. This is a huge "duh," but patients often report people miss this critical way of showing we see and value a human. Tip #3 – Sit down when talking to a patient who is in a chair or bed. Get yourself at eye level. It shows respect and caring, and leaves patients feeling you spent more time with them than you actually did. Tip #4 – Always end a patient encounter by asking if there is anything they need or if they have any questions. This routinely happens in many other industries, including impersonal call centers. We should be able to do better than a call center! Tip #5 – Eliminate jargon. All of us, from clinical to clerical, have phrases we use with each other that patients do not understand. Each employee should review his or her typical conversations to identify such words and find substitutes. Use friends and family members who don't work in healthcare to get a realistic idea of what the public understands. Tip#6 – Give patients information about time. Keep them updated about what will happen next, when it should happen, and why they are waiting. We may think it is obvious that their blood test results will not be instantaneous, but it is not obvious to patients. Tip #7 – Give patients information about their condition, treatment and prognosis. People are afraid of the unknown, but we rarely admit that. Having information helps us feel in control, and allows us to plan. Patients appreciate caregivers who provide information. And patients often need the information repeated, because it is usually too much to take it all in at one time. Tip #8 – Show respect and caring for the patient's visitors. Talk to them, let them know (if the patient agrees) what is going on, and let them know you care about the patient and are doing everything you can to help them. Ask them if they need anything or have questions. Tip#9 – Acknowledge people in halls or other public areas. Smile, nod, and say good morning. It shows people you see them, and you care about them as human beings. This is true for patients, visitors, and other employees. Tip #10 – Have all employees think about their own encounters with patients, and how they could improve the patient's experience. Be sure non-clinical employees are part of this, since they do see patients and family members. Let everyone identify ways they can personally make a difference. Please contact us if we can give you more ideas or answer your questions about this article. We can also help you create a culture of service that improves both the patient experience and employee engagement. Our email is anita@anitawoodward.com, and our phone is 216-631-1852.
Case Study
The following situation really occurred. Consider using it as a case study for quick discussions in staff meetings. The man was getting an MRI in preparation for cancer treatment. He had never had the procedure before. The tech did not give him any information about what to expect, how long the procedure would last, etc. A roll pillow was put under the patient's legs, which caused them to go to sleep and begin to spasm during the procedure. The tech chastised the patient for "moving your legs and ruining the picture," but simply tried to take it again without adjusting the pillow. What is your reaction to this case study? How do you think the patient felt? What improvements could have been made in this encounter? How do you know whether such types of things are going on during encounters with patients in your setting?
Story ideas, case studies wanted! We are looking for good case studies to share, and we always want to publish articles that answer your questions or help with your challenges. Please email us with your ideas. Thanks.
About This Newsletter This newsletter is published for clients and colleagues of A. Woodward & Associates, and for others who are interested in customer service, employee relations, and organizational communication, especially in healthcare organizations. If you would like to add someone to our subscriber list, please contact us at anita@anitawoodward.com(or simply reply to this email). Be sure to provide the subscriber's name and organization. If this newsletter is reaching you in error, we apologize. To unsubscribe, please email us and put "Unsubscribe" in the subject line.

Anita Woodward & Associates | 1892 West 44th Street | Cleveland | OH | 44113