Assessing healthcare quality is no simple task. Historically, the work has involved a symphony of government agencies, professional groups, researchers, and clinical pros all piping in on the processes they believe signify quality. But in more recent years, those measures have undergone major changes to emphasize patient outcomes rather than delivery processes.
The question everyone’s essentially trying to answer is, “Are healthcare organizations delivering the right things, and are those things making a difference in patient health?”
We’ve noticed two new trends emerging on the quality stage that attempt to more fully answer that vital question:
First, let’s take a look at U.S. News & World Report’s latest “Best Hospitals: Specialty Rankings” list. Over the last 30 years, evaluators have repeatedly tweaked the formula that determines what high-quality specialty care looks like because — as we’ve said quite often — quality is a moving target.
This year, for the first time, the U.S. News specialty hospital methodology now includes patient experience scores. In other words, consumer satisfaction data influenced which of the 4,500 qualifying hospitals were ultimately deemed the “best” (165 made the list). Data was taken from the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) survey, and the scores received 5% weight in the final rankings. (U.S. News)
HCAHPS has been around since 2008, and it’s a valuable measure because it gathers data from all sorts of patients, not just those on Medicare. The survey asks people recently discharged how often they experienced 21 positive factors such as good communication, clear discharge instructions, and quiet hospital rooms. Nearly three million patients completed surveys between July 2017 and June 2018 — more than 8,000 patients per day. (CMS)
That’s some good data. But it’s not without its critics.
A collection of healthcare leadership groups in July urged CMS to consider some updates to HCAHPS, possibly adding measures on the billing process, parking, and hospital food, for example. What’s more, the groups also want the survey to account for social determinants of health. (FAH)
We expect CMS will continue reviewing and making changes to HCAHPS to better reflect consumer needs and priorities. It will certainly be an interesting discussion at the very least!
Next, let’s take a look at who else is going to be rated for quality. We heard earlier this month that CMS is ready to phase in the requirement that health plans must display their quality ratings on all the marketplace insurance exchanges for the 2020 open enrollment season. (CMS)
Previously, health plan quality information was available on less than half of the marketplace sites, the rest being idle while CMS rolled out guidance and beta testing. It’s been a long haul, but at last, ratings display is ready for prime time. (Health Affairs)
Plan ratings — measured on a five-star scale — encompass 38 measures in three categories: medical care, plan administration, and…wait for it…member experience. The member experience component is based on member satisfaction with doctors, care services, and ease of access. Power to the consumer!
Our Take: Quality measures will continue to evolve, shifting toward greater emphasis on the consumer perspective. Likewise, increasing out-of-pocket expenses will continue driving consumers to think more critically about their healthcare expenditures as well as their healthcare experiences. With 81% of consumers dissatisfied with their healthcare experiences, it’s clear that providers and health plans have a lot of work to do to bridge the gap. Consumers already have more choices in the emerging Smart Health Market, so improving the consumer experience will be critical to healthcare organizations’ successes.