Issue link: https://beckershealthcare.uberflip.com/i/1475102
24 PATIENT & CAREGIVER EXPERIENCE An HCAHPS update is needed urgently By Rick Evans, Senior Vice President of Patient Services and Chief Experience Officer of NewYork-Presbyterian Hospital V irtually every adult inpatient hos- pital in America administers the HCAHPS survey to patients. e data from these surveys are publicly report- ed for all to see, and star ratings are assigned to hospitals based on this patient feedback. In addition, results of these surveys are a driver of the government's Value-Based Purchasing program, which rewards or penalizes hospitals based on performance. HCAHPS and other CMS-mandated quality measures are ingrained into most hospitals' goal setting and operations. e stakes on performance are high. When HCAHPS came into being in 2006, followed by the first public reporting of results in 2008, it was a game changer. e survey shined a bright light onto the im- portance of patient experience and elevated improvement work to a new level. ere were great benefits from this change. Patient experience improved across the country with survey measures rising year over year until the pandemic. e advent of HCAHPS moved many hospitals from an ad hoc approach to improving patient experience to a much more strategic stance. is was good for everyone — patients, families and our care teams. at was nearly 15 years ago. e survey tool and process has barely been adjusted since. At the same time, healthcare and our society have changed. Patient expectations and priorities have evolved dramatically, especially informed by their experiences in other parts of their lives. Technology has transformed many elements of the care experience that the HCAHPS survey mea- sures. Healthcare has become an ecosystem of both in-person and virtual interactions. It's a whole different world. e survey that changed the landscape in 2006 is now outdated. It is only allowed to be administered on paper. Additional survey modes — especially digital modes such as email and texting — must be deployed. e questions asked also need to be re-evaluat- ed to evolve with patient expectations. An update is way past due and needs to happen now. If updates are not implemented soon, I fear that we risk losing some of what we have gained in recent years. A looming concern is that response rates for the paper HCAHPS survey are declining year over year. More paper surveys than ever land in the junk mail pile and eventual- ly the trash. Lower response rates mean we are getting less and less feedback from our patients. is is noticed by our care teams - and especially our physicians and other clinicians. ey have been great partners in the work of improving patient experience. e relevancy of the data is paramount to them. e credibility of our work is at stake. Make no mistake, if we lose that hard won buy-in from clinicians, our efforts will be in jeopardy. ere are also concerns about the range of perspectives that are collected with a paper survey. Generational differences and concerns about healthcare equity need to be factored into the survey tool and the modes for survey administration. Patient advocates around the country have been very vocal about these issues. An updated tool and process is needed to harness all voices. ere is also the risk to the work of patient experience itself. e visibility that HCAHPS gave to the importance of patient experience as a quality and business imperative has been critical to harnessing precious resources — especially hospital budgets — to support improvement. is investment helped us improve the critical interactions that are essential for patients and the care team to achieve the outcomes we all desire. Advances have also been made in related areas such as patient engagement, diversity and inclusion and the caregiver experience. A body of knowledge has grown around these and other key issues and areas of focus. As I have said, all these advances were hard won. e credibility of data from surveys such as HCAHPS is foundational to all of the above and must be preserved. In recent months, I've seen several arti- cles in the literature that are questioning HCAHPS, and, to some degree, the im- portance of patient experience work itself. ere is a danger of conflating the impor- tance of the work with the survey tool itself. We must be clear about the distinctions here, and we must update the source data that drives so much of the work. CMS has already undertaken an effort to evaluate and update the HCAHPS survey tool and modes. In fact, testing of these items is underway. I laud CMS for doing this. But the pace must be accelerated. e factors I have already mentioned threaten to overtake what has been accomplished in recent years. We need a more relevant survey in multiple modes, and we need it as soon as possible. n 1 in 3 physicians reported mistreatment in past year By Cailey Gleeson N early 30 percent of physicians reported experiencing discrimination and mistreatment from patients or patients' family members or visitors, a study published May 19 in JAMA Network Open found. Researchers surveyed 6,512 physicians nationwide about their experiences with mistreatment and discrimination from Nov. 20, 2020, to March 23, 2021. The research was conducted in collaboration with the American Medical Association. Approximately 1 in 5 physicians experienced a patient or family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. Researchers also found that mistreatment or discrimination experience was independently associated with higher odds of burnout. "This is a staggering number," said Lotte Dyrbye, MD, one of the study's au- thors and a senior associate dean of faculty and chief well-being officer at the University of Colorado School of Medicine. "Simply having patients or family members say, 'No, you can't provide care because of the way you look' — not because of competency — is really heartbreaking.'" n