Much discussion about pay-for-performance has focused on how hospitals measure up against one another clinically and how the dollars may be divvied up accordingly. So far there has been less emphasis on how patients perceive their hospital care and how the public reporting of that data may drive quality improvement and eventually hospital revenue.
Thats about to change.
Beginning this month, hospitals subject to the inpatient prospective-payment-system provisions are required to submit data from a standardized survey of their adult patients to receive their full annual payment update from the CMS for fiscal 2008. Beginning in March 2008, the data culled from these patient surveys will be posted publicly on the Hospital Compare Web site. Hospitals that choose not to submit and publicly report the data may receive an update that is 2 percentage points lower than their peers.
The Consumer Assessment of Healthcare Providers and Systems hospital survey, known as HCAHPS, is the standardized survey hospitals must use to report their patient-experience data to the CMS. The first national standardized survey of hospital patient experiences, HCAHPS has been a joint project of the CMS and the Agency for Healthcare Research and Quality.
We went into this really with the idea that (patient experience) is a measure of quality, says Chuck Darby, social science administrator for AHRQs Center for Quality Improvement and Patient Safety. Its not what someone might call an objective measure, but at the same time it is a measure, and its an important perception.
Darby has led the AHRQ team that designed the survey with recommendations from various industry stakeholders. The National Quality Forum endorsed the survey in May 2005.
In the short term, hospitals need to be aware that consumers, employers, insurers and legislators may use this comparative data to decide where to seek care or where to steer patients. In the longer term, they should also be mulling how their payments might be affected by what patients are saying about them. In some regions, this is already beginning as private insurers incorporate patient perceptions into their pay-for-performance initiatives. And the CMS may not be far behind.