Improving HCAHPS Scores and The Patient Experience

Gerald Taylor MBA

Managing Director, TPMG Global

Patient satisfaction is an important and commonly used indicator to measure the value of health care. Across the United States, shifts in health-care policy have tied hospital and physician compensation to patient experience measures that focus on patient engagement.  As of late, understanding and improving the patient experience has become almost a burning platform for U.S. healthcare executives.  The patient experience survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), serves as a remarkably effective guide for the success of doctors and hospitals.

Res Ipsa Loquitur – Facts About the Patient Satisfaction

According to McKinsey & Company, many health systems make large investments in initiatives to improve the patient experience but fail to achieve their desired objectives. 

Here are some interesting facts about patient satisfaction:

1. Performance on the HCAHPS survey can affect up to 33% of a physician’s reimbursement.
2. 25% of value-based purchasing reimbursements are tied directly to HCAHPS scores.
3. In fiscal year 2020, 55% of the approximately 2,800 participating hospitals received approximately $1.9 billion in CMS value-based purchasing program incentive payouts – roughly $1.3 million per hospital.
4. Health system executives find that roughly 70 percent of their patient experience initiatives fail.

McKinsey also concludes that hospital in-depth data analysis and research can be better at pinpointing which factors most strongly influence patient satisfaction levels.  Moreover, TPMG Global® research has discovered more than half of healthcare facilities across the United States find the most difficult barrier to improving HCAHPS scores is focusing on the right drivers of “Would Recommend Hospital.”  And that is what this article is about.

In this piece we will discuss how to pinpoint the drivers that most strongly influence “Would Recommend Hospital,” and how to overcome common flaws which wreak havoc in patient experience initiatives. 

Improving HCAHPS Scores and The Patient Experience

Many in the healthcare industry believe there are few financial rewards for improving and sustaining respectable HCAHPs scores.  However, according to a study by the Deloitte Center for Health Solutions:  Hospitals with excellent HCAHPS patient ratings between 2008 and 2014 realized an average net margin of 4.7%, as compared to just 1.8% for those with low ratings.   

At TPMG Global, we believe improving patient satisfaction is not about making patients happy – par se’, but about improving the patient’s entire experience across the continuum of care.   The patient experience encompasses not just the clinical aspects of care delivery, but also the administrative, operational, cultural and behavioral characteristics of the entire care delivery system.   The object of improving the patient experience is to yield greater value by not only producing higher HCAHPS scores, but to also maximizing a facility’s reimbursements and sustaining meaningful improvements in real patient satisfaction.

To that end, we offer a simple 5 step method for improving the patient experience.

1. Put the HCHAPS survey into the field
2. Conduct the appropriate data analysis
3. Pinpoint the drivers that most strongly influence “Willingness to Recommend Hospital”
4. Conduct the appropriate qualitative analysis
5. Implement a plan, do, check, act test of change

This article will provide you with two easy step-by step data analysis methods that will pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital.

An HCAHPS Case Study – Hospitals in the Same System are Not Alike

A large hospital, part of an even larger system:  HCAHPs Survey Analysis 2014 – 2018

Case Study Problem Statement:  This healthcare facility is part of a larger healthcare system on the eastern cost of the United States.  For more than 4 years they have not been able to improve their stagnant patient satisfaction scores.  The head of the facility’s patient experience team instinctively knew the patient satisfaction driver report they received from their system’s central office was not focusing on the right factors.  They needed a change.

Baseline Analysis:  Since 2014, their HCHAPS “Willingness to Recommend” score has averaged 77.32 – ranking the facility between the 50^th and 75^th percentiles.  Though their scores are better than both the state (69) and national (72) results, the baseline analysis covers a serious weakness.  The facility’s scores fall below the national ratings almost 17% of the time and its performance misses the 90^th percentile mark of 84 (their goal) 94% of the time. 

Interpreting HCAHPS: Pinpointing the Determinants of Patient Satisfaction

To pinpoint the right drivers that most strongly influence willingness to recommend, there are 2 kinds of analysis you must perform.  The first type establishes linear cause and effect relationships between the drivers of patient satisfaction and their willingness to recommend a hospital. The other proves dependencies between those drivers and the same outcome.  Most importantly, the data analysis must be “statistically significant” to have the predictive power and confidence needed to ensure an initiative will generate a strong return on the time, hard work, and capital invested.

The Results:  Drivers of Patient Satisfaction – Linear Relationships

Drivers of Willingness to Recommend	Relative Strength
Governing Strength	R – Square:  .74
Drs Explained Things Understandably	Impact  -0.40
Treated w/ C&R by Drs	Impact  0.35
RNs Listened Carefully to You	Impact  0.50
Told What Medicine Was For	Impact  0.30
Treated w/ C&R by RNs	Impact  0.42
Received Phone Call at Home	Impact  0.14
P-Value	0.000000021

The table above identifies 6 statistically significant drivers of the patient experience that best determines Willingness to Recommend Hospital.  The key performance indicators suggest the following:

1. R-Square:  the subset of characteristics, outlined here, are a 74% driver of patient satisfaction.  Other variables (26%) may also drive Patient Satisfaction but may not be captured by the survey.
2. P-Value:  we can be 99.9999979% confident these are the appropriate drivers of patient satisfaction for this facility.

Critical to Satisfaction Characteristics

The model indicates, a one-point improvement in “Treated with Courtesy and Respect by Doctors” drives Willingness by 0.35 points; a one-point improvement in “RNs Listened Carefully” drives Willingness by 0.50 points etc…  (Linear Relationships)

Drivers of Patient Satisfaction – Dependent Relationships

Now that we have determined the fundamental drivers of patient satisfaction, we move forward to discover the extent to which patient satisfaction is dependent upon them.  Here, we evaluate the relationship between the attribute “Treated w/ C&R by RNs” and “Willingness to Recommend.”  The approach tells us the extent to which Willingness to Recommend is dependent on Treated w/C&R by RNs.

The basic idea of the method is to compare the observed performance of the driver with its expected performance.  If there is no dependent relationship between the potential driver and outcome, the actual frequencies at which willingness to recommend is observed will be close to their expected frequencies (in the norm).

Conclusions 

All other things remaining equal – the analysis indicates that we can be 99.995% confident – patients punish Very Good performance but reward Excellent performance in this category.  It appears performing very good in this category is not good enough. The hospital must be excellent to be rewarded with a willingness to recommend rating. For Very Good performance, patients are 59% less likely to “Definitely Recommend Hospital”.  For Excellent Performance in this category, patients are 89% more likely to “Definitely Recommend Hospital”.  Only 23% of patients give an excellent rating for this category!  

At the end of the day, we can safely conclude Willingness to Recommend Hospital is not only strongly driven by Treated with Courtesy and Respect by RNs, but it is also dependent on the driver for improvement.   In addition, the opportunity for improvement (OFI) is substantial!    The charter for the patient experience initiative should include an objective and key result (OKR) for this driver, like:  Improve the percentage of respondents for “Treated w/ C&R by RNs” with an excellent rating by 77% (predicted target date – here). 

I trust this article has provided you with insight and approaches that can help you pinpoint those drivers that most strongly influence a patient’s willingness to recommend a hospital. If you are interested in learning more about using these methods, contact us at:  TPMG Global® – Improving HCAHPS Scores and The Patient Experience

Gerald Taylor is the Managing Director at TPMG Global®

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