Wow! What’s Happening With Patient Satisfaction?

CARING Magazine March 2008
Dr. Robert Fazzi, Managing Partner
Gina Mazza, RN, BSN

In the past, many would quietly say that it is a second tier consideration for agencies; others, that it has no impact on the financial stability of their agency. And still others would have said, “If CMS doesn’t focus on it, why should we?”

Patient satisfaction has long been the weak sister (or brother) of quality. While there are always strong advocates for patient satisfaction in agencies, valid and reliable measures and the use of benchmarking has been treated as far less important than those measures that affect the clinical or financial stability of agencies. But, oh, how things have changed!

Patient Satisfaction… Moving to Center Stage

CMS is now moving from rhetoric to making patient satisfaction an integral part of total quality measurement and management. CEOs are now finding measures of patient satisfaction being tied into their performance appraisals by their board or hospital system. Agencies that use benchmarking systems are recognizing that they have a strong differential when it comes to marketing. And most recently, studies by benchmarking companies show that strong patient satisfaction correlates with strong clinical and financial outcomes.

Let’s start with CMS. A December 6, 2007 Federal Register Notice announced that the Agency for Healthcare Research and Quality (AHRQ) will begin a field test of a home health survey instrument in 2008. This 54 question survey is one of a group of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys being developed by AHRQ.

The survey being tested includes questions related to the staff providing care, pain, medication management, dealing with the office, customer service, and likelihood of recommending the agency to family or friends. Questions validated in this study will ultimately be required of agencies with one universal question expected to become part of the Home Health Compare measures.

Patient Satisfaction and CEO Performance

A growing number of the more sophisticated agencies and boards see patients’ experiences as critical to the success of their agency. Rather than simply talking about patient satisfaction, they recognize that the best way to ensure that their agency focuses on patient satisfaction is to include it in their performance appraisal system.

A strong proponent of this is Barbara Ballard, President of Bon Secours Home Care- Hampton Roads. “We include it not only as one of the measures of performance success for our clinicians; we include it for everyone in senior management including me. Twenty percent of my performance is based on patient satisfaction. When you include something like this as a measure used in a person’s performance appraisal, you can be assured that they are paying attention to it,” says Ballard.

Patient Satisfaction and Quality and Financial Outcomes

Two new separate studies by the nation’s two leading patient satisfaction benchmark services found what may be the most compelling reason of all for why patient satisfaction is steadily moving to center stage. The use of patient satisfaction benchmark services was found to correlate with stronger Medicare financial profits, better Home Health Compare composite scores, and better outcomes on specific Home Health Compare measures.

Chart I. Patient Satisfaction and Benchmark Results

In a study of over 100 agencies, Fazzi’s Patient Satisfaction Benchmark Service Researchers found that the use of patient satisfaction benchmark services by agencies correlated with stronger Medicare financial profits, higher Home Health Compare percentile scores on specific measures and a better overall Home Health Compare composite score. In terms of quality scores, consider the chart above.

The same was also true when it came to financial outcomes. Agencies who scored in the top third of patient satisfaction had an average Medicare profit margin/episode that was 3 ½ percent higher (18.3 percent versus 14.9 percent) than those who did not use a benchmark system.

In an another study of 57 agencies who subscribed to both the Press Ganey patient satisfaction service and OCS OASIS service, it was reported in the January/February 2008 Remington Report that, “numerous correlations between standard satisfaction, utilization, case mix, and quality metrics” were found.

• Agencies with higher percentage of patients improving in transferring also had a higher proportion of patients that were likely to recommend the agency to others.
• Patients trust in aides “technical skills” were correlated with reduced length of stay and reduced adverse events (re-hospitalization) associated with longer LOS.
• Patient perception that staff kept family informed was correlated with reduced utilization cost.

What is clear is that whether you measure the impact of patient satisfaction through a single integrated system or by combining the services of two companies, the findings are still the same: patient satisfaction does impact clinical outcomes as well as financial. Both groups now include the means to measure and improve patient satisfaction by clinical diagnosis, by payor source or by nearly any other measure desired by an agency.

Patient Satisfaction and the Future

Patient satisfaction is clearly moving to center stage for agency performance. A growing number of agencies now go far beyond simply measuring and benchmarking patient satisfaction. They use it to differentiate themselves when marketing. They use it as part of a quality performance appraisal tool. And, they use it as means to impact their quality and financial outcomes. With CMS now pushing to have patient satisfaction part of an integrated quality measurement system, they are taking an aggressive step to make it an integral part of agency operations.

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About the Authors: Gina Mazza, RN, BSN, is the Director of Fazzi Associates National Patient Satisfaction Benchmark Service and BestWorks®, Fazzi’s National Operational, Financial and Quality Best Practice Improvement Service. She is an author of numerous articles on quality improvement and a frequent presenter at state and national trainings. Gina can be reached at gmazza@fazzi.com.

Dr. Bob Fazzi is the Founder and Managing Partner Fazzi Associates. He is an author, researcher and consultant who has provided consultation and training to the home care and hospice community for over thirty years. Most recently he has served as Co-Director of the Philips National Technology and Telehealth Study. Bob can be reached at bfazzi@fazzi.com.