The CMS this year will start to lay groundwork to base hospitals' Medicaid and Children's Health Insurance Program reimbursement in part on how satisfied parents and their children are with the care they receive.
In October 2014, the Agency for Healthcare Research and Quality posted a pediatric version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey now used by Medicare to track patient satisfaction in hospitals.
The child HCAHPS was funded by AHRQ and the CMS and developed and field-tested by Boston Children Hospital's Center of Excellence for Pediatric Quality Measurement in collaboration with the Consumer Assessment of Healthcare Providers and Systems Consortium.
In a Dec. 30 notice (PDF) posted on Medicaid.gov, the agency revealed that it will pilot a reporting process this year to determine whether to include Child HCAHPS results in the core measure set of quality metrics now used by State Medicaid and CHIP programs.
Should the effort prove successful, it's expected that child HCAHPS will ultimately factor into reimbursement as the adult equivalent does now for Medicare, experts say.
The survey was recommended to address variations perceived in pediatric inpatient care, patient experience and care coordination, the CMS said in the notice. There was no universal tool to track and compare hospitals' performances in those areas.
“It was felt there was a major gap and [CMS] wanted to fill it,” said Dr. Mark Schuster, chief of division of general pediatrics, medicine at Boston Children's Hospital. “Our goal was to give voice to families.”
Sample questions include how well parents feel nurses and physicians listen to them and their children and how they communicate about medications.
In fiscal 2014, the adult HCAHPS data accounted for 30% of hospitals' total performance scores in the CMS hospital inpatient value-based purchasing program. HCAHPS results also are publicly reported on the Hospital Compare website.
There has been some criticism of the adult HCAHPS by the provider community because of the impact it can have on a hospital's reimbursement. Some experts believe that hospitals serving more challenging patient populations are more likely to score low on the assessments. Others say the surveys might lead doctors to put too much emphasis on making patients comfortable and happy.
“The mantra some doctors use in keeping their patients satisfied is to never deny a request for pain medication, antibiotics, scans, or even hospital admission,” Dr. Michael Murphy, CEO of ScribeAmerica, a medical scribe company, wrote in an analysis.
Micah Solomon, customer service and patient experience consultant and author of Exceptional Service, Exceptional Profit: The Secrets of Building a Five-Star Customer Service Organization, said some institutions “approach success in HCAHPS by trying to game the system: to focus too specifically on the questions on the survey,” Solomon said.
Supporters of HCAHPS, however, have say there's no evidence for such claims. “I find that argument silly,” said Paul Cleary, dean of the Yale School of Public Health. “It's just not true.”
Follow Virgil Dickson on Twitter: @MHvdickson
