As a result of the Patient Protection Affordable Care Act, a portion of a hospital’s CMS reimbursement is now tied to its performance on HCAHPS. This new connection occurred through a program referred to as the Hospital Value-Based Purchasing Program (HVBP Program). One key component of that program is the Patient Experience Domain, which currently accounts for 25% of a hospital’s performance in the HVBP Program.
Through a somewhat complicated algorithm, the hospital’s HCAHPS surveys are converted into a Patient Experience Domain Score; this becomes part of the Total Performance Score and influences the hospital’s CMS reimbursement. If the hospital is able to significantly improve its HCAHPS standing in relation to the rest of the nation or if it achieves a very high standing in relation to the rest of the nation, it can dramatically improve its Total Performance Score and consequently its CMS reimbursement.
The study confirms the idea that if your organization can drive up its Overall Hospital Rating, you can expect to see a reduction in HPL claims per 100 beds.
Since one key intersection between reimbursement and liability appears to be the Overall Hospital Rating, the next reasonable step is to create a targeted strategy to impact that number.
In 2016, the Center for Medicare & Medicaid Services (CMS) performed an analysis of HCAHPS scores based on 3.2 million surveys. The study identifies 5 HCAHPS categories that are most closely tied to the Overall Hospital Rating score.
HCAHPS Category | Overall Hospital Rating |
Communication with Nurses | 0.64 |
Communications with Doctors | 0.50 |
Responsiveness of Hospital Staff | 0.51 |
Pain Management | 0.54 |
Communication about Medications | 0.48 |
According to the evidence, the most effective approach to improve your reimbursement and reduce your liability must start with an investment that drives improvements in these 5 HCAHPS categories.
Patient experience is an area of healthcare that will continue to evolve. However, armed with the evidence-based approach, an organization can develop a strategy to strengthen its reimbursement and reduce its professional liability costs.