In addition, patient motivation to fill out a survey can bias results because it may be those who had an extreme experience – either superb or terrible – who are more likely to respond to the survey.
How can gastroenterologists stay ahead of the curve?
Despite the limitations in patient experience surveys mentioned earlier, they are likely here to stay and directly will impact physician compensation and hospital reimbursement for care.5
Although CG-CAHPS is not yet mandated for outpatient clinics and ambulatory surgical centers, gastroenterologists in community and academia should begin taking the steps outlined later to improve their practices before the results become publicly reportable. There is a paucity of well-designed studies that show improvement in HCAHPS after an intervention. The literature is anecdotal and individualized. Hence, it is more important for gastroenterologists to focus on culture, infrastructure, and processes to identify their specific opportunities than it is to adopt specific recommendations.
First, shift your thinking from resenting these surveys to embracing them as an opportunity to improve every aspect of care we provide as a health care team. This would entail making patient experience a priority for all staff and granting them the authority to positively impact the customer experience.
Second, identify resources that help conduct surveys efficiently and effectively. Most academic medical centers and community hospitals have set up interdisciplinary quality-improvement teams that can be a good starting point to learn about ongoing patient experience initiatives. The widespread use of tablet computers and patient experience survey applications have made it easier to conduct patient surveys for internal use at the point-of-care, often at a fraction of the cost of mailed paper surveys.6
Third, stay proactive by regularly reviewing survey information and identifying areas of poor experience in your practice. This can be accomplished by identifying within-practice variation (comparing members of the same practice), between-practice variation (comparing one’s practice with other similar practices), evaluating time trends (comparing current scores with your past scores), or comparison with national benchmarks. It is important to remember that direct physician care is not the only place to examine when trying to improve patient experience scores. As patient care transitions to team-based models, every member of the team is central to providing an optimal patient experience. In fact, some of the common issues that adversely affect patient experience relate to attitude of the front desk staff, the cleanliness in the office, or timely access to care. Hence, it is important to work as a team – staff and physicians – to design solutions to the specific patient experience issues.1,2,3
Conclusions
A value-based purchasing initiative is now required under the Patient Protection and Affordable Care Act as part of the 2010 national health care reform legislation. Patient experience surveys, despite limitations, serve an important role in patient-centered care and value-based purchasing. Hospital-based HCAHPS currently is mandated by the CMS, and clinic-based CG-CAHPS will soon follow suit and provide data for the publicly reported Physician Compare website. A proactive approach to patient surveys that uses a team-based approach and health information technology will help gastroenterologists stay ahead in the changing landscape of health care delivery.
References
1. Raman, A., Tucker, A. The Cleveland Clinic: improving the patient experience. Harvard Business Review. September 12, 2011.
2. Merlino, J. Speaking from experience. When doctors improve communication, patients become better partners. Mod. Healthc. 2012;42:30.
3. Malone, L.E. Surveys: tracking opinion. National Science Foundation. Available at: http://www.nsf.gov/news/special_reports/ survey/index.jsp. Accessed: June 10, 2013.
4. Center for Medicare & Medicaid Services. HCAHPS fact sheet (CAHPS hospital survey). Available at: http://www.hcahpsonline.org/ files/August%202013%20HCAHPS%20Fact%20Sheet2.pdf. Accessed: June 10, 2013.
5. Allen, J.I. The road ahead. Clin. Gastroenterol. Hepatol. 2012;10:692-6.
6. Atreja, A., Rizk, M. Capturing patient reported outcomes and quality of life in routine clinical practice: ready for prime time? Minerva Gastroenterol. Dietol. 2012;58:19-24.
Dr. Rizk is quality improvement officer, Digestive Disease Institute, and clinical assistant professor, Cleveland Clinic Lerner College of Medicine; Dr. Atreja is chief technology innovation and engagement officer, medicine, and assistant professor and director of Sinai AppLab, gastroenterology, Icahn School of Medicine at Mount Sinai, New York; and Dr. Merlino is chief experience officer, Cleveland Clinic. Dr. Rizk and Dr. Atreja disclosed that they are investors in Innowaiting.com (Dawazu, LLC). The remaining author discloses no conflicts. Dr. Atreja is supported by a Crohn’s and Colitis Foundation of America Career Development Grant.
