CAHPS measures are as important as profit and loss for hospitals

by Steve P. Sanders, DO, MBA

Are hospitals coming clean? An article recently published in Health Affairs reveals details of a government–required survey conducted in 2008 and 2009.

The Hospital Consumer Assessment of Healthcare Providers and Systems survey or CAHPS is required of all hospitals receiving and hoping to continue to receive federal funding. Analysts compared CAHPS responses between 2008 and 2009 and gleaned what they believed were meaningful conclusions. The survey asked patients questions about nine different areas of their inpatient experience from communication with doctors and nurses to cleanliness and quietness. The survey unequivocally showed hospitals are getting better—or are they?

It doesn’t give us comfort that the only way the government could get hospitals to send out and then share their survey results was by threatening to withhold a two percent payment increase. Before this government–induced stick approach, a little more than half of US hospitals completed the CAHPS patient surveys. After the fiscal threat, more than 80 percent of hospitals found the time to get them done. As one of the most consumer intensive industries in the current economy, one would think that hospitals would survey their consumers as often and as public as possible. Improving the customer’s experience has always been the hallmark of for–profit businesses, at least the ones that hope to survive and flourish in today’s economy.

What was more interesting is the one percent overall improvement in the nine areas measured from one year to the next. The smallest improvement was in recommending the hospital to others; regrettably it showed no improvement in patient’s communication with physicians. The authors of the study boasted that hospitals are seeing “meaningful improvement” from their efforts to improve patient care. Only in American health care would one percent be considered ‘meaningful.’

The nine areas measured by the CAHPS must be nailed down tight by American hospitals. Using CAHPS questions as operating indicators, each hospital board should check where they are with respect to the measures, why they’re not close to 100 percent patient satisfaction, and how they are going to get there—quickly. The CAHPS measures are as important as profit and loss, and as many hospitals have discovered are often the same. It is increasingly clear that the government wants to change the delivery of health care in this country. Hospitals have to step up and quickly prove their unrelenting pursuit of dramatically improving the patient’s experience, or their independent survival is at risk.

Steve P. Sanders is an internal medicine physician.

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  • http://glasshospital.com GlassHospital

    I’ve been working on making the case that we need a more concerted effort (led by a doc) to senior management of our academic medical center.

    The get the business case for it now (i.e. the ‘stick’ of HCAHPS), but based on my conversations, it seems they’re only in it for the bottom line reasons and managing ‘perceptions’ rather than really doing the hard work of improving the patient’s experience.

    The post raises the comparison of for-profit businesses always being interested in what their customers think. Health care anomalous in two ways, then:

    1. mostly not-for-profit, therefore (some think) that just by showing up we’re doing a good job
    2. patients are the customers but it’s their insurance that’s the payor–and that’s governed under big contracts where the incentive is on doing stuff, and lots of it.

    Will be interesting to see if/how PPACA affects this.

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