CMS Market Update on CG CAHPS and the OU Physicians Experience

Transcription

1 CMS Market Update on CG CAHPS and the OU Physicians Experience August 19, 2015 Holly Adams, OU Physicians Matthew Bates, Studer Group 1

2 CMS 2015 Program Year: CG CAHPS Surveys ACO or PQRS? NO Not addressed by CMS in 2015 PQRS ACO # of EPs? 100+ EPs 2-99 EPs Required to administer the CAHPS for ACOs survey at your cost and using a CMS approved vendor. Required to administer the CAHPS for PQRS survey at your cost and using a CMS approved vendor. Options to administer the CAHPS for PQRS survey at your cost and using a CMS approved vendor. Source: CMS Website accessed on and 2015 CMS-Certified Survey Vendor Reporting (CAHPS for PQRS) Made Simple v1.0 2

3 CMS CG CAHPS Surveys (6-month longitudinal) PQRS: 80 questions / 12 domains ACO ACO-9 (required) 71 questions / 9 domains ACO-12 (optional) 80 questions / 12 domains Domain PQRS ACO Getting Timely Care, Appointments, & Information Required Required How Well Your Providers Communicate Required Required Courteous & Helpful Office Staff Required Required** Patient s Rating of Provider Required Required Care Coordination* Required Optional Access to Specialists Required Required Health Promotion and Education Required Required Shared Decision Making Required Required Health Status & Functional Status Required Required Between Visit Communication Required Optional Helping to Take Medication as Directed Required Optional Stewardship of Patient Resources (ACO-34) Required Required Source: CMS Websites accessed on ( and Notes: *Test Results Core Question is bundled in Care Coordination Domain ** Required for ACOs to report but not scored 3

4 CMS Certified Vendors for 2015 CAHPS Surveys Vendor PQRS* ACO** Avatar Solutions (FL) X X Center for the Study of Services (DC) X X DataStat, Inc. (MI) X X DSS Research (VA) X X HealthStream Research (TN) X X Ipsos (IL) X Management and Technology Consultants, LLC (IN) X MetrixMatrix, Inc. (NY) X X Morpace, Inc. X National Research Corporation (NE) X X Novaetus, Inc. (MI) X Percy & Company Market Research (LA) X Press Ganey Associates (IN) X X Professional Research Consultants, Inc. (NE) X X Research & Marketing Strategies, Inc. (NY) X X SPH Analytics (GA) X X SullivanLuallin Group (CA) X The Jackson Group (NC) X Thoroughbred Research Group, Inc (KY X Tonka Medical Association, LLC (MN) X WBA Research (MD) X Notes: Bold indicates CMS Certified for both PQRS and ACO surveys for 2015 (11 Vendors) * CMS Certified for 2015 CAHPS for PQRS Survey (14 vendors) ** CMS Certified for CAHPS for ACOs Survey (18 vendors) More Info: Source: CMS Websites accessed on ( and 4

5 PQRS CAHPS Timeline for Patient Initial Visit (Q4-14 to Q2-15) Survey Conducted (Nov-15 to Feb-16) Provider Compare Publication FY17: VBP Penalty Risk (Oct-16 to Sep-17) New Critical 2015 Deadline (Sept 22, 2015 at 5pm): All Group Practices must select a CMS approved CAHPS for PQRS Survey vendor. Group Practices must complete the 2015 CAHPS for PQRS Vendor Authorization form and send it to the address on the form between July 24, 2015 and 5 pm ET September 22, Group Practices must select a vendor from the final list of approved CAHPS for PQRS Survey vendors. CMS link for more info: Source: CMS Website accessed on and CMS CAHPS for PRSQ Survey Quality Assurance Manual v1.0 July

6 What is CMS going to do with Your FY2015 Program Year CG CAHPS data? PQRS Payment: Report PQRS metrics satisfactorily for the 2015 program year to avoid an 2017 PQRS negative payment adjustment. ACOs Payment: Leverage the ACO-9 survey data as part of the ACO alternative payment calculations Public Reporting: The domain level data at the group level will be posted on the CMS Physician Compare website in late 2016 if technically feasible. Public Reporting: The domain level data at the group level will be posted on the CMS Physician Compare website in late Source: CMS Website accessed on 8-` and 2015 CMS-Certified Survey Vendor Reporting (CAHPS for PQRS) Made Simple v1.0 6

7 OU Physicians Overview Oklahoma City, OK 1,000+ credentialed providers 1,200 employees 68 clinic locations 600k ambulatory visits $230M annual revenue AAAHC Accreditation NCQA PCMH Recognition Full GE Centricity EMR deployment 75k CGCAHPS surveys since July % e-surveys July

8 Building an Culture We are what we repeatedly do. Excellence, then, is not an act, but a habit. - Aristotle 8

9 Evidence Based Leadership Foundation Leader Evaluation Leader Development Must Haves SM Performance Gap Standardization Accelerators Implement an organizationwide leadership evaluation system to hardwire objective accountability Aligned Goals Aligned Behavior Aligned Process Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Must Haves Rounding Thank You Notes Employee Selection Pre and Post Phone Calls Key Words at Key Times / AIDET Re-recruit high and middle performers Move low performers up or out Agendas by pillar Peer interviewing 30/90 day sessions Pillar goals Leader Eval Mgr (LEM) Discharge Call Manager (DCM) Monthly Meeting Model

10 National Percentile Ranking Patient Experience Milestones AIDET Rounding EXCEL Incentive Pillar Goals & Alignment Leader Evaluation Manager Monthly Meeting Model Standards of Behavior Accountability Matrix CPR Meetings Visit Status Boards (Early Transparency) Employee Engagement Toolkit Access to Care - Referral Tracking 69 Individualized Patient Care (IPC) Clinic Visit Summary Physician Coach 71 Online Star Ratings & Comments Transparency Culture 78 LEAN MD Engagement Internal Transparency 88 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FYTD 15 * Based on Press Ganey s National Facilities Database as of 5/1/15. 10

11 CGCAHPS Percentile Ranking 73 rd %tile 80 th %tile 79 th %tile * Based on Press Ganey s National Facilities Database as of 5/1/15. 11

12 Building a Culture of Alignment, Accountability & Action 12

13 Studer Group Five Fundamentals AIDET A I D E T Acknowledge Introduce Duration Explanation Thank you 13

14 The Impact of Communication in Healthcare The research Strong positive correlation between health care team communications and patient capacity to follow through with: Medical recommendations Self-manage a chronic medical condition Adopt preventive health behaviors Clinician s ability to explain, listen and empathize can have a profound effect on functional health outcomes as well as overall experience of care. Source: The Impact of Communication in Healthcare. The Institute for Healthcare Communication, July

15 Patient Safety & Adherence The research 25% of Americans report they did not follow their provider s advice due to the following reasons(1): 32% felt instructions too difficult to follow and they didn t understand what they were supposed to do. Research conducted from demonstrated that ineffective team communication was the root cause for ~66% of all medical errors during the period(2). Source: 1)Room for Improvement: Patients report on the quality of their health care. Commonwealth Fund, ) Team Strategies and tools to enhance performance and patient safety (Team STEOOS), DOD and AHRQ. 15

16 Why are Key Words so Important? Provide a consistent experience to patients, families, visitors and internal customers Build relationships Help the patient and/or internal customer understand their care better Align the behavior of associates and providers to the needs of the patients and internal customers 16

17 Truth People will forget what you said, people will forget what you did, but people will never forget how you made them feel. - Maya Angelou 17

18 Accountability Best Practices The glue that makes it stick but not just any glue! Gorilla Glue Strength 1. Monthly Meeting Model (MMM) 2. LEM & Leader Report Cards 3. Accountability Matrix 4. Annual Leader Performance Evaluation 5. Clinic Performance Review (CPR) Meetings 18

19 Monthly Meeting Model Structured process for conducting one-on-one leader meetings to ensure alignment with organizational goals and optimal performance. o Leader Report Card Annual goals are established with monthly performance updates. LEM score evaluated. o o o o o 90-Day Plan LDI Linkage Grid Rounding Logs Thank You Notes People Plans developed for all goals not at target. Created at beginning of each quarter. Utilized to monitor incremental progress toward goals. Follow up/validation tool to assess impact of leader learning from the DI sessions. Updates and completed items are are noted and reviewed. Leader asks specific questions about rounding experience to identify patient issues and/or concerns. Recognition and reward of high performers. Manage up opportunity for the manager. Highly impactful retention tactic. Specific questions asked about onboarding/status of new hires, employee and provider engagement, turnover, etc. 19

20 Leader Evaluation 20

21 Patient Experience Best Practices 21

22 22

23 CGCAHPS Access to Care - Appointment Scheduling Online appointment scheduling via patient portal or other resource Monitor performance targets (lag days, 3 rd next available appt, etc.) Utilize AIDET to set expectations Consider alternative ambulatory care delivery models (i.e. telemedicine visits, e-visits,) Offer alternate provider options and engage providers in managing up 23

24 CGCAHPS Access to Care - Call Management Maintain call tracking system/log Mystery shop Eliminate/reduce on-holds, transfers, and abandoned calls. Utilize after-hours answering service Follow-up with patients the day after an after-hours call 24

25 CGCAHPS Access to Care - Managing Waits It begins with appointment scheduling Set realistic expectations and upfront Text or call in advance Room n Round, Timers Provide patient with options to reschedule Leverage technology for selfchecking options 25

26 CGCAHPS Access to Care - Managing Waits Placed near the clinic front desk, the visit status boards provide an update status of each provider. Provide an updated timeline for seeing the provider. Restaurant style pagers in addition to boards. Transparency and timeliness appreciated by patients. 26

27 27

28 CGCAHPS Test Results - Best Practices Track test result status in EMR. Develop a clinic policy regarding test result process: o o Turnaround time (TAT) Communicating results Leverage the Clinic Visit Summary Share test results via patient portal/secure message Post provider-specific results transparently 28

29 Test result tracking EMR documentation of communication to patient. 29

30 30

31 CGCAHPS Office Staff Courtesy Best Practices AIDET & validation process/procedure Behavioral-based interviewing Hands-on skills labs with role playing and manager coaching Mystery shopping (phone and onsite) Individualized patient care / comment cards Clinic visit summary Minimizing waits/delays 31

32 Purpose: New employee skill development Clinic managers are coached on quality of feedback provided Built into leader action plans 32

33 33

34 CGCAHPS Physician Communication Physician Coach AIDET training for providers New provider orientation Transparency in reporting 34

35 Transparency Movement 35

36 Patients use the Web to Find MDs Patients are demanding more transparency and searching the web for health services/information. 72% look online, 77% of them use Google/Bing to start (Pew Research). 59% think online ratings are important in choosing a doctor (AMA) Dozens of health websites (Healthgrades, Vitals, Angie s List, etc.) advertise physician ratings, invite consumer input and purport to provide objective patient reviews of MDs. In actuality, most ratings are based on limited, unverified or incomplete data and can provide skewed reviews of physicians. Recognizing all of these factors, other physician groups around the country are posting their own scores on their websites (Wake Forest, Utah, Piedmont, Integris, etc.). 36

37 What Patients Find on Google Tim Moser, MD (Family Physician) Before: Healthgrades 4.3 stars, 24 reviews Wellness.com 4.5 stars, 18 reviews Ucomparehealthcare 5.0 stars, 7 reviews Now: 37

38 Why Provider Transparency & Online Reviews? 1. Controlling the Conversation With more of our patients looking to online physician reviews, we can provide valid, robust data to highlight the quality of our physicians. 2. Driving the Perception Take control of our reputation and brand in the market and drive significantly more traffic to our website where we can better manage the message. 3. Realizing Greater Utility of our Patient Satisfaction Data Leverage the thousands of returned patient experience surveys on our oumedicine.com website to provide valuable data for patients as they select a provider. 4. Fostering a Culture of Accountability Drive transparency within the organization and community around key areas of patient experience and in the future, quality of care. 38

39 Star Ratings & Online Posting Criteria Go-live, July 1, 2015 CGCAHPS Overall physician rating & physician communication quality domain Top Box scores are converted to 5-star ratings and posted on findadoc.oumedicine.com. N of 30 required before survey ratings and comments are be posted online. Cumulative N count moving forward. Comments that contain patient health information, profanity or libel/risk management issues will not be posted (~53 to date). Each comment is reviewed by the Transparency Advisory Group, a committee consisting of physician, operations, risk management and marketing representatives, to determine if it meets posting criteria. Comments are published (on-line), flagged (for further review/consideration, or archived (exclusion criteria was met/not posted). If a provider objects to the posting of a comment, he or she can appeal and ask that the comment be removed from their page. All appeals should be ed to TAG@ouhsc.edu. During the appeal process, the comment will be removed and will only be re-posted if the appeal is denied. 39

40 Summary of Ratings & Comments (as of 8/11/15) # COMMENTS BY STAR RATING 3 Stars, 45 2 Stars, 30 1 Star, 11 Approximately 1,592 patient comments have been published (since notification to patients on 2/10/15): 4 Stars, 74 5 Stars,

41 Rating Count Provider Ratings (as of 8/11) Providers & Ratings Count (N) 29 AND BELOW % of providers have ratings posted # of Providers 41

42 Provider Profile findadoc.oumedicine.com 42

43 National Percentile Ranking Patient Experience Milestones AIDET Rounding EXCEL Incentive Pillar Goals & Alignment Leader Evaluation Manager Monthly Meeting Model Standards of Behavior Accountability Matrix CPR Meetings Visit Status Boards (Early Transparency) Employee Engagement Toolkit Access to Care - Referral Tracking 69 Individualized Patient Care (IPC) Clinic Visit Summary Physician Coach 71 Online Star Ratings & Comments Transparency Culture 78 LEAN MD Engagement Internal Transparency 88 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FYTD 15 * Based on Press Ganey s National Facilities Database as of 5/1/15. 43

44 Reporting Transparency - CGCAHPS 44

45 Meaningful Use Internal Transparency Report 45

46 Comments Report Internal Transparency 46

47 Tips for Gaining Physician Buy-in Leadership buy-in must drive the initiative. Identify a senior physician leader as champion/spokesperson. Communicate early and regularly (FAQs, monthly committee meetings, newsletters, s, staff meetings, etc.) Consider a transparency workgroup with provider representatives. Develop a provider appeals procedure for concerns to be vetted. 47

48 Tips for Gaining Physician Buy-in Prepare a forecasted star rating and mock up web page for all providers to get a sneak peek. Identify provider coaches to help with tips to improve the patient experience. No surprises. Everything up front and in the open. Transparency is best in doses over time. Guage your organization s readiness before deciding on a go-live date. 48

49 Advice The decision to (or not to) pursue transparency must be made and led by senior physician leadership. Get organized, plan early, over communicate. Adopt important prereqs before pursuing online transparency. Don t assume providers have current data about their performance. Provide it for them. Be flexible and, Don t lose sight of the real reason for pursing transparency. 49

50 The Voice of an OU Physician Patient 50

51 Thank You! Holly Adams, FACHE, FACMPE Executive Director of Clinical Operations & Community Health OU Physicians (405) Matthew Bates, MPH Senior Leader, Physician Solutions Studer Group (720)