By this fall, hospitals that want to continue receiving Medicare payments will be required to publicly report patient satisfaction using a survey now under development.
HHS' Agency for Healthcare Research and Quality is creating a standard patient-experience survey that hospitals will be required to administer as early as September, according to Centers for Medicare and Medicaid Services Administrator Tom Scully. Hospitals regularly will publish aggregate results to help consumers make better choices about which hospitals provide the best care, he said in an interview with Modern Healthcare.
"It's very important to have patient experience included as a dimension of quality," said Carolyn Clancy, a physician who last week was named director of the AHRQ after serving as interim director for 11 months. "It affects whether care actually gets executed well." The CMS plans to issue a proposed regulation in May or June, which will be followed by a 60-day public comment period, according to the agency.
The survey will become a condition of Medicare participation, Scully said.
Disseminating patient-satisfaction data is the latest CMS initiative to promote quality among the nation's healthcare providers. Last week, the Leapfrog Group, a business coalition, said it plans to partner with the CMS (See story, p. 17).
Last December, the CMS, along with the American Hospital Association and other industry groups, unveiled a voluntary reporting initiative to publicize information about how hospitals perform in three common disease areas. At the time, those groups mentioned patient satisfaction surveys as an offshoot of their initiative that would be based on the Consumer Assessment of Health Plans Study used by insurers, purchasers and others interested in how people perceive their health plans.
Similar surveys for hospital patients since have moved to the front of the CMS' radar screen.
Demonstration projects to test the survey system are under way in Arizona, Maryland and New York. Medicare's quality-improvement organizations in those states are developing and testing the survey in conjunction with the AHRQ to "make sure there's one format useful to patients and consumers," Scully said.
The vast majority of hospitals already survey patients using a variety of instruments from different survey firms. Creating a standard instrument would facilitate hospital-to-hospital comparisons.
"Standardization makes for a more extensive comparison," Clancy said. Still, she added, hospitals could incur costs from conforming to new specifications and administering surveys more broadly than they do now. "The administrative burden and issues of when to do the survey will unquestionably affect (hospitals') expenses," Clancy said. The CMS has not yet specified how often the surveys would be administered or how frequently hospitals would report data, but Clancy said the first patient-satisfaction information could be published as soon as early next year.
Hospitals may balk at such a rapid mandate.
"The introduction of a new requirement would be best served by an experimental period that is voluntary and during which both the providers and the government can learn from experience and then develop the instrument that would be in the best interests of patients, providers and government oversight," said the Rev. Michael Place, chief executive officer of the Catholic Health Association.
One hospital lobbyist said the timeline for implementing a new rule could be too tight given the need for the CMS to coordinate with the industry and develop a survey simple enough that patients will willingly complete it.
A draft of the patient-satisfaction survey includes 68 questions that gauge patients' experience with regard to the courtesy of caregivers, the hospital environment and overall rating of performance, in addition to other factors.
"In its current form (the survey) seems that it could be long and cumbersome and expensive and disruptive," said Mel Hall, CEO of South Bend, Ind.-based Press Ganey Associates, which uses its survey to measure patient satisfaction in some 1,500 hospitals. "During field testing they will learn there are other ways to do this."
Clancy agreed a shorter questionnaire is preferable to one with too many questions that could confuse patients or make them less likely to answer. Clancy and Scully said the survey under development is a compilation of several industry instruments already in use.
"We do not have a formal relationship with the CMS or the AHRQ," said Joe Carmichael, senior vice president of National Research Corp., a Lincoln, Neb.-based company that receives most of its revenue from measuring patient satisfaction. "Our continuing work is by and large essentially to continue to support (the survey) and bring our perspective, as well as those of our clients, to the table."