Hospitals that wish to survey their patients and publicly report the results will soon have access to a standardized survey tool developed by the Agency for Healthcare Research and Quality, the CMS announced last week.
The patient satisfaction survey, known as HCAHPS, asks patients to describe the quality of care they received by rating the hospital itself, responsiveness of staff, pain control, cleanliness and other factors. Former CMS Administrator Tom Scully initially planned for the survey to be mandatory but backed down in the face of industry pressure (July 7, 2003, p. 4).
Controversy erupted around the survey itself. One survey firm, the Gallup Organization, sued Scully for unfairly favoring another vendor, National Research Corp., as the source for the survey. Ultimately, the survey was not based on any one vendor's product but a combination of several approaches, as well as comment from the public and industry, according to the CMS.
After public comment, the AHRQ completed its draft of the 25-question survey, which is now being reviewed by the National Quality Forum, a not-for-profit that endorses national standards for measuring and reporting healthcare performance data.
"The survey will be put through our consensus development process on an expedited basis," said Philip Dunn, an NQF spokesman. Officials said they expect a final survey to be available to hospitals early next year.
Last week, the NQF named members to the survey review committee. James Varnum, president of the Dartmouth-Hitchcock Alliance in Lebanon, N.H., and Gerald Shea, director of governmental affairs for the AFL-CIO, will co-chair the 22-person committee, which includes several hospital representatives.
The committee plans to meet Dec. 1 and will accept public comment on the HCAHPS survey before revising it and securing final approval from NQF member councils and the board.
"Having apples-to-apples comparisons will help us address the strengths and weaknesses of healthcare providers so they can improve the quality of care patients get," HHS Secretary Tommy Thompson said in a news release.
Already, some 70% of the nation's hospitals survey patients after their stay, said Nancy Foster, senior associate director of policy at the American Hospital Association. The AHA has argued all along that the surveys should be voluntary and stands by that position now, Foster said.
"When this survey is ready to be broadly implemented, we will encourage our hospitals to adopt it and provide information back to the public," she said.
Also last week, the CMS proposed ambulatory-care measures that could eventually be used as the basis for a pay-for-performance system. The measures assess the quality of care delivered in areas such as coronary artery disease, diabetes, high blood pressure and behavioral health.
Demonstration projects to test the measures will begin early next year. The measures, which were developed by the American Medical Association and the National Committee for Quality Assurance, "would be used in a pay-for-performance program if one gets going," a CMS spokesman said. "This is all a first step."
In another development on the quality front, Sen. Ron Wyden (D-Ore.) last week introduced a bill that would link Medicare skilled-nursing facility payments to the quality of care they deliver, with rewards for better care and penalties for substandard care.