HCAHPS And Value
Based Purchasing 101
Truths of Current Healthcare
• HCAHPS/VBP are not going away.
• Healthcare is a business-All organizations must
generate a profit.
• Reimbursement is based on outcomes not effort.
• Patients are our mission and the mission ALWAYS
comes first.
• The Golden Rule applies to all situations.
• Nursing staff now has the unique opportunity to
become a revenue generator instead of a cost
What is CAHPS?
Consumer Assessment of Healthcare Providers and Systems
 Produces comparable data for public reporting
 Creates incentive for organizations to improve
 Enhances public accountability and transparency
Hospital CAHPS
Home Health Care CAHPS
Clinician and Group CAHPS
… more to come!
CAHPS provides an apples to apples metric for public
reporting—additional measurement may be needed for ongoing
quality improvement activities and monitoring.
4 Objectives of HCAHPS
• Standardization permits meaningful comparisons across
hospitals for public reporting
• Increased hospital accountability and incentives for quality
• Pay-for-performance (Hospital VBP)
• Enhanced public accountability
Why is CAHPS ® Important?
 Consumers have access to the data
 Consumers relate more easily to CAHPS data than to clinical
 Some use CAHPS data to choose hospitals
CAHPS is in the public eye
Media coverage
Promotion by hospitals themselves
Participation linked to reimbursement
Will have volume, revenue, and reputation implications down the
HCAHPS Content: Seven
• 1.Communication with nurses
- Nursing related questions comprise about 50% of Survey
• 2.Communication with doctors
• 3. Responsiveness of hospital staff
• 4. Pain management
• 5.Communication about medicines
• 6. Discharge information
• 7. Care Transition
Other Questions You Impact
Hospital Environment
 During this hospital stay, how often were your room & bathroom kept
 Never, sometimes, usually, always
 During this hospital stay, how often was the area around your room quiet at
 Never, sometimes, usually, always
Global Rating
 Using any number from 0 to 10, where 0 is the worst hospital possible and
10 is the best hospital possible, what number would you use to rate this
hospital during your stay?
 0-worst—10-best possible hospital
 Would you recommend this hospital to your friends & family?
 Definitely no, probably no, probably yes, definitely yes
General Survey Guidelines
Patient Eligibility
 Adult (18+)
 Medical, surgical or maternity care
 Overnight stay, or longer
 Alive at discharge
 Excludes hospice discharge, prisoner, foreign address, “nopublicity” patients, patients excluded due to state regulations,
and patients discharged to nursing homes, SNF swing bed
within hospital, and skilled nursing facilities
 HCAHPS encompasses ~80-85% of inpatients
Communication Guidelines
 Hospitals SHOULD
 Encourage response to the survey
 “It is permissible to notify the patient while in the hospital or at discharge
that they may receive a survey after discharge.”
 Improve the patient experience
 Distribute the communication guidelines
 Hospitals SHOULD NOT
 Ask patients for a certain score
 Indicate that their goal is to receive a certain score
 New: Show the HCAHPS survey or cover letter to the patient prior to
survey administration
 New: Mail pre-notification letter or postcards
Value Based
Value-Based Purchasing
Common Terminology: Pay for performance or Pay for quality
Health Reform Updates
Value Based Purchasing started in fiscal 2013
Current hospital VBP program will transition from “Pay-for-Reporting” to “Pay-for
Up to 2% of your Medicare reimbursement will be at stake
 Hospitals will lose reimbursement unless their performance is at benchmark
Includes HCAHPS performance and Core Measures
Will start at 1% and this will be ramped up to 2% by 2017
Who will be reimbursed for HCAHPS performance?
 Top performing healthcare providers
 Greatest improving healthcare providers
Hospital Value Based Purchasing - Measures
Future Measures
 AHRQ patient safety indicators, inpatient quality indicators and composite
 Nursing sensitive care
 AMI, heart failure and pneumonia mortality rates
Thank you for

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