The Centers for Medicare & Medicaid Services (CMS) has defined six National Quality Strategic priorities that will form the foundation of Medicare performance measures used to populate value-based reimbursement programs. These programs will directly influence our reimbursement in the years to come as we move away from fee-for-service payment. One of the Priority Strategies is person- and caregiver-centered experience and outcomes. Measuring patient experience is not easy, yet many gastroenterologists will be confronted with survey results collected by their practices, hospitals, and hospital systems. Dr. Rizk and his colleagues help us understand the framework, implementation, and implications of the major patient experience surveys used today. Many of us have used results from such surveys to identify gaps of care that can be improved in ways that impact our patient care.
John I. Allen, M.D., MBA, AGAF, Special Section Editor
Until recently, prioritizing patient experience was still a relatively novel idea. The general assumption was that because patients come to the hospital out of necessity rather than choice, health care providers could ignore customer service. Operating models typically focused on two improvement measures: positive clinical outcomes and cost containment. The major advances of the health care industry – cutting-edge treatments, technologically sophisticated delivery methods, high-efficiency protocols—have often come at the expense of patient experience, making care delivery increasingly impersonal and mechanized.1
Dr. Maged K. Rizk
By 2010, however, improving patient experience had become part of the mainstream health care agenda. In fact, a recent survey of health care executives found that 37% ranked "patient experience" as a top three priority, the second-most frequent answer just after cost reduction (40%).2
As health care transforms into a consumer-based model, there is increasing demand from health care institutions, insurance companies, and government to measure patient experience. Although a staple in many industries for years, this is a relatively new phenomenon in health care. The primary mode through which patient experience is assessed is with surveys, the most important being the government-mandated Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. This article provides an introduction to the use of surveys as an instrument for measuring patient experience, details government-mandated and private surveys, and suggests tools that may be beneficial in both measuring and improving patient experience.
Surveys: A scientific instrument
When performed correctly, surveys replace assumptions with data and serve as a scientific instrument for social and behavioral sciences by collecting information in the form of a structured set of questions, with the intention of revealing trends and patterns over time. In addition, but less commonly, surveys can be used as a tool to identify specific service recovery opportunities.3
There are important considerations when a survey is designed. How participants are selected is just as important as the number of participants. Specifically, surveys can vary from including every member of a group to including a sample cohort, which may or may not be representative and bias free. Who is approached for a survey and who responds to it depends on multiple factors including cost, feasibility, proximity to the experience, availability, whether the respondent received the survey through referral, the engagement and participation of those being surveyed, and whether incentives are provided.3 The verbiage and design of a survey also can introduce bias. Respondents tend to choose the first option from a list and to answer as they think they should rather than being truthful. Good surveys randomly sample respondents so they are representative, are designed to minimize selection biases, and adjust for known variables that can confound results.3
Trend toward standardized national benchmarking surveys
Dr. James Merlino
There has been a shift away from using stand-alone survey instruments developed by private companies (such as Press-Ganey) for internal use by health care organizations to using national benchmark surveys developed by Federal agencies for public consumption. Three broad goals have shaped this trend. First, standardization of both the survey tool and implementation protocol allow valid comparisons to be made across hospitals locally, regionally, and nationally. For example, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the first national standardized survey of patients’ perspectives of hospital care, has gone through rigorous development and testing by the Agency for Healthcare Research and Quality (AHRQ) including a public call for measures, literature review, cognitive interviews, consumer focus groups, stakeholder input, a 3-state pilot test, extensive psychometric analyses, consumer testing, numerous small-scale field tests, and input by the general public.4 Second, data collected from the national surveys are reported publicly to increase transparency of the quality of hospital care nationally. Third, performance on these surveys is tied to reimbursement and value-based payments to create new incentives for health care organizations to improve quality of care. Gastroenterologists need to be aware of these national standardized surveys (inpatient HCAHPS and outpatient Clinician and Group [CG]–CAHPS) because these will have direct implications for many aspects of care that will be provided in the future.
