- As a part of the industry push for value-based healthcare, healthcare professionals are facing calls to improve patient engagement.
However, patient engagement as a practice is difficult to define and difficult to measure.
To work towards achieving the Triple Aim – improving patient care, improving health of populations, all at a lower cost – federal agencies have established patient engagement measures, all with the end goal of improving the patient experience.
Regulatory requirements such as MACRA and meaningful use drive the use of health IT and patient portals to better engage patients and share patient data, while patient satisfaction surveys serve as feedback for patient experiences. CMS also employs its star ratings system to offer a comprehensive view of patient engagement at various healthcare organizations.
MACRA, meaningful use measure health IT engagement
MACRA and meaningful use are important regulatory programs that require providers to integrate patient engagement strategies into their health IT use. Specifically, the two programs call for providers to adopt patient portals and to share health data with their patients.
Currently, eligible hospitals and critical access hospitals are in the midst of Stage 2 Meaningful Use reporting. This second leg of the program requires participants to report on nine objective measures, two of which pertain to patient engagement.
For one measure, participants must use EHR technology to produce patient-specific education materials for at least one unique patient. Participants must also offer at least one unique patient the capability to view, download, and transmit (VDT) their personal health data.
In lieu of Stage 2 Meaningful Use, eligible hospitals and critical access hospitals may be taking advantage of the optional early start year for Stage 3 Meaningful Use. Under this part of the program, CMS has combined all patient engagement measures under one overarching objective, according to the final rule:
In the Stage 3 Patient Electronic Access Objective, we proposed to incorporate certain measures and objectives from Stage 2 into a single objective focused on providing patients with timely access to information related to their care. We also proposed to no longer require or allow paper-based methods to be included in the measures (80 FR 16753) and to expand the options through which providers may engage with patients under the EHR Incentive Programs. Specifically, we proposed an additional functionality, known as application programming interfaces (APIs), which would allow providers to enable new functionalities to support data access and patient exchange.
Under MACRA, eligible clinicians must also attest to patient engagement measures as a part of the Merit-based Incentive Payment System (MIPS).
“With these objectives we recognize that the Quality Payment Program provides new opportunities to improve care delivery by supporting and rewarding clinicians as they find new ways to engage patients, families and caregivers and to improve care coordination and population health management,” CMS said in an executive summary of the nearly 2,400-page rule.
Eligible clinicians must meet several patient engagement measures, including offering at least one unique patient VDT capabilities, patient-specific education materials, and access to health data using an application programming interface (API).
Eligible clinicians must also engage the patient in care coordination by making health data available for third-party transmission, producing after-visit summaries, direct messaging with other providers, and collecting patient-generated health data.
HCAHPS measure patient satisfaction
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are standardized industry questionnaires used to assess patient satisfaction and experience at various points of care. HCAHPS is the survey used in hospital settings.
The survey, developed in 2014 by the Agency of Healthcare Research and Quality, includes a total of 27 patient satisfaction questions. It includes 18 questions about a patient’s hospital experience, four population-specific sub-questions, three questions to compensate for varying demographics, and two questions to assess Congress-mandated quality measures.
This survey has two purposes. In addition to informing CMS of patient satisfaction and experience at various facilities (and informing the CMS star ratings system), providers also review their survey scores to make improvements. According to a May 2016 survey in the New England Journal of Medicine Catalyst, 52 percent of healthcare organizations used the CAHPS survey to measure and adjust patient satisfaction strategies in their facility.
Hospital star ratings represent patient experience
Hospital star ratings, a CMS initiative that publically presents a comprehensive view of hospital quality, serves an overarching assessment for patient engagement.
CMS calculates the star ratings using 64 quality measures that run the gamut of patient satisfaction (using CAHPS data), patient safety data, and quality of experience information. These 64 measures are then analyzed and represented in a star rating score of one to five.
The agency then publishes these ratings quarterly for public view, ideally to help patients make better decisions about where to access their care.
“It can be overwhelming when consumers are faced with having to choose a health care provider, such as a hospital, nursing home, or physician,” said Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer, in a 2014 blog post.
“Providers differ in the safety and quality of care they give, and having quality ratings available to compare providers can help consumers make more informed health care decisions.”
Despite these intentions, some healthcare professionals don’t think the star ratings are representative of what different facilities have to offer. Prior to the ratings’ final publication in summer 2016, Congress issued a letter to CMS asking them to modify their methodology for calculating the star ratings to be more representative of hospital quality.
The American Hospital Association, also critical of the star ratings methodology, issued a statement after CMS published the star ratings.
“The new CMS star ratings program is confusing for patients and families trying to choose the best hospital to meet their health care needs,” AHA said.
“Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers. And it adds yet another to a long list of conflicting rating and ranking systems.”
But some patient advocacy groups, such as the National Partnership for Women & Families, stepped in to defend the star ratings.
“Millions of patients and family members can now access a tool that provides important information on how their hospitals are performing on key health quality measures,” said Debra L. Ness, President of the National Partnership. “Consumers can use this trustworthy program to compare hospitals side-by-side. This is a huge step forward.”
Regardless of potential measure controversy, it is important for healthcare organizations to be cognizant of how CMS assess the patient experience. Some patient engagement measures, such as MACRA and meaningful use, have a significant effect on how Medicare reimburses providers.
And while there are no financial incentives tied to star ratings, ensuring a positive patient experience is still vital to an organization’s bottom line. Patients are increasingly in charge of decisions about where they access their treatment, and it is important for organizations to foster a positive reputation about their patient satisfaction and quality of care.
Understanding these measures will drive better performance, ideally yielding more engaged patients, satisfaction, and ultimately, hospital reputation.