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57 PATIENT EXPERIENCE CMS Updates Hospital Compare Data — How Many Hospitals Have 5 Stars for Patient Experience? By Heather Punke C MS updated patient satisfaction survey data on its Hospital Compare website April 28, which included cal- culating new HCAHPS summary star ratings for hospitals. CMS started assigning hospitals a one through five star rating based solely on HCAHPS scores in April 2015. To calculate these summary star ratings, CMS first gives star ratings to hospitals for each of the11 HCAHPS questions. e summary star rat- ing combines the 11 HCAHPS star ratings into one comprehensive metric. As of April 28, 3,499 hospitals had an HCAHPS summary star rating. e break- down is as follows: • Five stars: 188 hospitals • Four stars: 1,178 hospitals • ree stars: 1,493 hospitals • Two stars: 563 hospitals • One star: 77 hospitals CMS provides these star ratings to "enable consumers to more quickly and easily assess the patient experience of care information that is provided on the Hospital Compare website," according to the CMS website. Researchers are divided on if these star ratings will actually drive patients to higher-quality hospitals, since the ratings are based solely on patient experience scores, not on patient outcomes, and many industry leaders had ad- verse reactions to the ratings. One study, published in JAMA Internal Med- icine in April 2016, found hospitals with higher HCAHPS star ratings actually do have lower mortality and readmission rates. "ese findings should be encouraging for policymakers and consumers; choosing five- star hospitals does not seem to lead to worse outcomes and in fact may be driving patients to better institutions," the authors concluded. "It is reassuring that patients can use the star ratings in guiding their healthcare-seeking decisions given that hospitals with more stars not only offer a better experience of care, but also have lower mortality and readmissions." e JAMA Internal Medicine study aligned with another study published in April 2016 in the Journal of Patient Experience that found statistically significant associations between the number of stars for patient experience and multiple clinical outcomes — higher star rat- ings meant lower complication rates and read- missions, the researchers found. However, a study from Quantros published in August 2016 produced contrary findings and said the star ratings are "misleading and may actually steer patients to hospitals with poor clinical outcomes." Regardless, CMS updates the HCAHPS sum- mary star ratings every quarter. It is important to note patient experience star ratings differ from CMS' Overall Hospital Quality Star Rating program, which incor- porates outcomes measures as well as patient experience scores. e overall star ratings will be updated in July. As of the December update, here is the breakdown of overall star ratings: • Five stars: 83 in December • Four stars: 946 • ree stars: 1,794 • Two stars: 694 • One star: 112 n Nurses Sitting at the Bedside Linked to Higher Patient Experience Scores By Heather Punke P atients' perception of nurse communication factors into both Press Ganey and HCAHPS patient experi- ence scores, and an initiative at one Texas hospital shows the simple act of sitting down with patients can im- prove those scores. According to a study published in the Patient Experience Journal, a nurse manager at a 369-bed hospital in Texas designed a "commit to sit" initiative to improve the hospi- tal's nurse communication composite score. The theory behind the initiative is active listening is an in- tegral factor of the nurse communication score. The hospi- tal's nursing team determined being at eye-level with the patient and making eye contact are qualities of active lis- tening, and since patients are typically laying in bed, sitting is the best way to be at their eye level. Therefore, as part of the initiative, the new expectation was for nurses in the telemetry unit to sit with all patients during their shift. They were trained to ask patients, "Do you mind if I sit and talk with you?" and then talk with the patient while sitting. This simple action had a positive effect on pa- tient experience scores. As a result of the initiative, the hospital's nurse composite score improved from the 9th percentile in 2014 to the 43rd percentile in 2015. "Effective communication between patients and caregivers improves the patient experience as well as outcomes," the study concludes. "Taking a few minutes out of each shift to connect with each patient fosters relationships and shows compassionate care." n