Revamping Survey Skills to Measure Patient Satisfaction and Experiences

Some private payers are currently basing a component of pay-for-performance on reporting patient satisfaction and experiences, and it appears that this trend may soon be implemented into practice by public payers as well.¹

As of now, under the Patient Protection and Affordable Care Act (PPACA), Medicare is required to include "an assessment of patient experience and patient, caregiver, and family engagement" on the Medicare Physician Compare Website by January 1, 2013. By 2015, experts in this area predict that Medicare may likely tie physician reimbursement and pay formula in part to the measurement of patient experience. On the hospital front, reporting patient survey data is already a becoming a requirement for receiving full reimbursement; in fact, starting in 2013, hospital reimbursement will be tied into reported patient-experience data.¹

To stay ahead of the curve, some practices have already begun collecting patient satisfaction and experience data. Practices can opt to design the patient surveys themselves or work with a third-party vendor to conduct them. According to an American Medical Association (AMA) report, "If payers are not already surveying patients and tying the results to payment rates, they will be soon... How best to do the preemptive surveying depends on a practice's budget, whether the physicians want to ask highly specific questions about the practice rather than standard ones, whether they are interested in benchmarking against physicians across the country, and how closely they are interested in mimicking payers' surveys."¹

In particular, the AMA report cites that, in working with vendors, some may use question formulations similar to those that are drafted by the US Department of Health and Human Services (HHS) for physician offices, called the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). If an oncology practice chooses to develop its own survey, a number of templates, tools, and guides are available to navigate through the process. Some of the considerations involved in designing a survey may include: method of survey implementation (ie, paper-based vs electronic), use of standardized questions for normalized data, and frequency of language updates to questions, as well as, the level of detail and information it would like to know about its own operations and processes, among other factors. Survey design experts suggest that surveys must be "as brief as possible while still eliciting meaningful responses." In the AMA report, one expert says that survey questions should typically be ordered chronologically: "Start questions where the visit begins, or even before. How long did it take to find parking? How long was the wait before the patient was seen by a nurse? How long did the front desk staff treat the patient? The questions can continue through the visit, right to asking about follow-up care."¹

One area that experts tend to disagree on is how the patient surveys should actually be conducted. Some believe that practices should provide the surveys to patients following their appointments outside of the practice setting, such as through an online vendor website or the practice's website. Such an approach would allow the patient to focus more on the medical issues of the appointment and perhaps more opportunity to be honest on the survey. On the other hand, once a patient has left the practice, it may be difficult for the pull-through and follow-up to occur. In addition, patients may also be reluctant to participate in surveys; here, experts think that it is important for oncology practices to demonstrate the value of participant feedback by visibly showing the results of their participation as soon as possible. One physician in the AMA report is cited saying, "The [physician] asking the patient is a really good way. Patients are really loyal to [physicians]. They want to do what's recommended. They want to please them."¹

Once the survey data become available, the next step—perhaps the most important step—is to channel the information into action items and incorporate the feedback into meaningful follow-up, including:¹

• If surveys include physician-specific data, meet with physicians to talk about results.
• Suggest specific actions in the practice to improve low scores.
• Follow up with coaching by a trusted colleague.
• If the practice can afford it, benchmark results with those in the same specialty around the country.
• Share strong patient satisfaction scores with payers when it comes time to negotiate contracts.
• Post survey results in the office waiting area and link the result to a specific change the practice has made. For example, if patients said they wanted better waiting room reading, get better magazines and let patients know the change was made in response to their feedback.

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Surveying patient satisfaction and experiences is likely going to be tied into reimbursement over the course of the next several years, and to be prepared, oncology practices may want to plan ahead and evaluate the considerations of both developing a patient survey, as well as, the processes involved with rolling it out.

Sample Survey Questions¹

CG-CAHPS, Agency for Healthcare Research and Quality
Q: In the last 12 months, when you phoned this doctor's office during regular office hours, how often did you get an answer to your medical question that same day?
A: 1. Never 2. Almost never 3. Sometimes 4. Usually 5. Almost always 6. Always

For more information and the complete survey, please visit:
www.cchri.org/programs/programs_pas.html

Patient Assessment Survey, Primary Care Physician Survey Instrument, California Cooperative Healthcare Reporting Initiative

Q: In the last 12 months, how often did this doctor seem informed and up-to-date about the care you got from specialist doctors?
A: 1. Never 2. Almost never 3. Sometimes 4. Usually 5. Almost always 6. Always 7. I did not see any specialist doctors in the last 12 months.

For more information and the complete survey, please visit:
www.cchri.org/programs/programs_pas.html

American Medical Group Assn. Patient Satisfaction Benchmarking Survey

Q: Would you recommend the physician/healthcare professional you saw to your family and friends?
A: 1. Definitely not 2.Probably not 3. Probably yes 4. Definitely yes

For more information and the complete survey, please visit:
www.amga.org/research/psat/index_psat.asp

For more information on patient satisfaction and experience surveys, please visit the following resource:
http://www.ama-assn.org/amednews/2011/04/18/bisa0418.htm