eAlerts CAHPS: An Introduction to Measuring Patient Satisfaction

CAHPS®: AN INTRODUCTION TO MEASURING PATIENT SATISFACTION

June 1, 2009

Patient satisfaction is an important component of most health care quality measurement systems. In 1995, the federal Department of Health and Human Services launched the CAHPS® program to develop standardized survey protocols asking patients to evaluate the interpersonal aspects of health care services. The acronym originally stood for “Consumer Assessment of Health Plans Study,” but as the program has evolved beyond health plans, CAHPS now means “Consumer Assessment of Healthcare Providers and Systems.” The program is funded and managed by the Agency for Healthcare Research and Quality (AHRQ). Its partners include many public and private organizations.

“HCAHPS” represents the standardized national patient survey system and data for hospitals. Since July 2007, most hospitals must collect and submit HCAHPS data in order to receive their full annual Medicare payment update. Hospitals that fail to report the required quality measures, which include the HCAHPS survey, may have their annual payment updates reduced by 2.0 percentage points. Hospitals implement HCAHPS under the auspices of the Hospital Quality Alliance (HQA), a private/public partnership that includes major hospital and medical associations, government and private payers, consumer groups, measurement and accrediting bodies and other groups with an interest in improving hospital quality. The HQA has endorsed HCAHPS. For further information, see http://www.hcahpsonline.org.

HCAHPS results are reported along with other hospital quality measures on www.hospitalcompare.hhs.gov. Many of our readers know that data from Hospital Compare – for example, on the frequency of timely administration of prophylactic antibiotics and other medical or surgical process measures – are important to their hospitals because patients are increasingly seeking comparative information on their “providers.”

Patient satisfaction with physicians is being measured under the CAHPS surveys. Ratings of clinicians’ communication and interpersonal skills appear in the original CAHPS survey of health plans (for which 11 years of results are now in the National CAHPS Benchmarking Database), and not just in the hospital surveys. Health plans are scored on questions such as “How often did your personal doctor spend enough time with you?” CAHPS launched a “Clinician and Group” set of survey instruments in 2007, targeted at primary care. No data from the Clinician and Group surveys have been published to date.

Admittedly patient satisfaction survey data are highly subjective and often are easy to challenge on the methodology used. Whether the patient felt that the physician was “respectful” may have very little to do with the clinical outcome of the surgical or anesthesia intervention – great surgeons may have terrible bedside manners. The argument over a role for these data is over, though. Patient experience measures are embedded in every quality benchmarking program. The ASA itself asserted that performance data “should include . . . clinical outcomes data, patient satisfaction and resource utilization” in its Guiding Principles for Management of Performance Measures as amended in 2005.

There is not yet any “Anesthesiologist-CAHPS” or even a “Perioperative CAHPS.” The 23-member Surgical Quality Alliance, of which the American Society of Anesthesiologists is a member, in 2007 contracted with two well known health policy organizations to develop a CAHPS survey instrument for surgical and anesthesia care. According to the latest information available, the draft instrument was to have been submitted to AHRQ for endorsement last October. (Hoy E., Measuring Patient Experiences of Care. Bull. Am. Coll. Surgeons; 2008, 93:5, 13-16). There is as yet no reference to a surgical CAHPS on the AHRQ website.

The CAHPS Hospital Survey is highly relevant to anesthesiology groups, nevertheless, because your hospital’s results reflect the value of your patient interactions. The HCAHPS Core Composite measures include physician and nurse communication skills, as well as pain management, as shown by the extract from the CAHPS Pocket Guide below:

If you can give the hospital data demonstrating not only that you have ensured the timely administration of prophylactic antibiotics (and perhaps compliance with protocol for prevention of catheter-related bloodstream infections as well other clinical quality measures), but that you have also contributed to surgical patients’ positive regard for the hospital, you should be in a better position at the negotiating table with hospital administration.

Groups may adopt a variety of questions in patient surveys of their own – and many anesthesia groups already have. Sample questions that may be answered on a numerical scale, reflecting agreement or disagreement with the statement, include:

The anesthesia plan was explained in terms I understood.
Postoperative pain management options were explained in terms I understood.
I was satisfied with the management of my postoperative pain (and of my pain during the procedure, if it was performed under sedation only).
I had little or no postoperative nausea and/or vomiting.
My anesthesiologist was courteous, considerate and sensitive to my needs.
I would recommend my anesthesiologist to other patients.

Patient satisfaction is one of the four major domains on which anesthesia quality is measured in the Quantum Clinical Navigation System™, a specialty-specific quality benchmarking program developed by Richard Gilbert, MD, MBA, of Southeast Anesthesiology Consultants in Charlotte, NC. Many of you have had the opportunity to view demonstrations of the Quantum CNS system at anesthesia conferences or in webinars. Further information on Quantum, and on other topics addressed in this announcement, is available from This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Before closing and wishing you a good week, we would like to draw your attention to important new information on the content and timeline for consideration of congressional health system reform posted on the ASA website (www.ASAhq.org)on May 29. As we discussed last week, this is the time to make your views known to your Senators and Members of Congress. The ASA website is doing an excellent job of keeping everyone up to date on the issues.

Sincerely,

Tony Mira
President and CEO