Want More CMS Patients and Higher Reimbursements? Improving Patient Satisfaction and CAHPS Scores May Help

Want More CMS Patients and Higher Reimbursements? Improving Patient Satisfaction and CAHPS Scores May Help

The adage “Happy customers are good for business” is practically universal whether in healthcare or any other industry. That is because happy customers typically:

• Become returning customers

• Influence others to become new customers

• Reinforce employees to continue providing excellent service

In healthcare (where “customers” and “patients” are synonymous), there are many ways to measure and improve patient satisfaction as there are reasons for measuring and improving them.

There are two patient satisfaction measurements from HCAHPS (Hospital Consumer Assessment of Healthcare Providers & Systems) that are noteworthy for their impacts on CMS (Centers Medicare & Medicaid) reimbursements and patient volumes:

CAHPS surveys

• HCAHPS star ratings

How Do CAHPS Surveys Affect CMS Reimbursements?

CAHPS survey scores are an important part of how acute-care hospitals receive VBP (value-based purchasing) reimbursements from CMS. Here’s a simplified overview of how they are connected:

• VBP hospitals receive a portion of CMS reimbursements based on their TPS (Total Performance Scores).

• A chunk of TPS is determined by the PEC/CC (Patient and Caregiver Centered Experience of Care/Care Coordination domain).

• PEC/CC is determined by CAHPS surveys.

Put most simply: If your VPB patients experiences are good, you can get higher CMS reimbursements.

How Do HCAHPS Star Ratings Affect CMS Patient Volumes?

Although CAHPS survey results are published each year, it is done for accountability and not for the public to use as a way to do comparison shopping for hospitals—which is where HCAHPS star ratings enter the picture.

HCAHPS has explained its star ratings are intended to:

• Enable consumers to more quickly and easily assess the patient experience of care information.

• Provide a quick summary of each HCAHPS measure in a format that is increasingly familiar to consumers.

Putting it most simply once again: If your VBP patients report good experiences, you’ll probably get more VBP patients. And, if you treat those new patients as well as you treated the earlier ones.

Healthcare CRM: An Overlooked Key to Improving CAHPS Survey Scores and HCAHPS Star Ratings

There is much more to measuring patient experience than knowing if a sick or injured patient was made better or well. Instead, patient satisfaction scores relates to a host of other factors that focus more on a patient’s experiences—several of which were touched on in the Patient Engagement HIT article, “How Hospitals Can Raise Patient Satisfaction, CAHPS Scores”:

• Clear patient-provider communication

• Hospital cleanliness and noise levels

• Attentiveness and reducing unnecessary discomfort

• Discharge and follow-up process

Although Patient Engagement HIT shared some valid solutions for how to improve patient experiences in ways that relate to improving CAHPS scores, it missed a crucial one: There was no mention of healthcare CRM solutions such as patient management platforms and medical call centers.

No, healthcare CRM solutions cannot control the comfort of the bed or the “bedside manner” of doctors or nurses—nor was it designed to. But they can have tremendous impacts on many factors that are part of the patient experience, especially with administrative functions like intake, discharge, communications and more.

Putting it most simply one final time: If you have the tools to provide superior patient experiences, you can get better CMS reimbursements and more CMS patients!

How much do your CAHPS survey scores and HCAHPS star ratings influence your facility’s focus on improving patient experiences?

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Brian Malone Sequence Health’s Contact Center Director.

Sequence Health is a cloud-based technology and services company that improves profitability and patient outcomes for hospitals and practices through end-to-end patient engagement solutions backed by clinical and non-clinical teams. Its HIPAA-compliant, SaaS platform improves care team workflows, automates patient communication and tracks patient progress to optimize the patient journey. Since 2004, leading healthcare providers have trusted Sequence Health to help acquire, manage and engage patients through complex episodes of care.