Executive Insight

Welcome

January 2012

Welcome back to HCAHPS Executive Insight, the gold button on the HCAHPS On-Line Web Site, www.hcahpsonline.org.

In January, the Centers for Medicare & Medicaid Services (CMS) refreshed the HCAHPS results on the Hospital Compare Web site (www.hospitalcompare.hhs.gov) The new HCAHPS scores are based on patients discharged between April 2010 and March 2011.

Highlights

HCAHPS data for First Quarter 2010 were rolled off of Hospital Compare, while First Quarter 2011 results were rolled on

The January 2012 scores are based on more than 2.7 million completed surveys from 3,837 hospitals

Put differently, on average, every day more than 25,000 patients are surveyed about their hospital experience; every day more than 7,500 patients complete the HCAHPS survey

News and Notes from the HCAHPS Project Team

HCAHPS and Hospital Value-Based Purchasing: A Brief Overview

In this edition of HCAHPS Executive Insight we present an overview of the role HCAHPS scores play in the new Hospital Value-Based Purchasing program. In the future we will move this content, updated as needed, to a new section of the HCAHPS On-Line Web site, “HCAHPS and Hospital VBP.“ We hope that www.hcahpsonline.org will become a handy resource for hospitals, survey vendors and others interested in HCAHPS’s role in the Hospital VBP program.

Briefly, Hospital VBP links a portion of Inpatient Prospective Payment System (IPPS) hospitals' payment from CMS to performance on a set of quality measures. The Hospital VBP program was first presented in a Report to Congress in November 2007 and was established by the Patient Protection and Affordable Care Act of 2010. Several Final Rules issued in 2011 set out the parameters of the program for FY 2013 and FY 2014.

For more information about Hospital VBP, please visit CMS' dedicated Web site, http://www.cms.gov/Hospital-Value-Based-Purchasing/. The slide set from CMS' July 2011 “Open Door Forum“ on the Hospital VBP program can be found at http://www.cms.gov/Hospital-Value-Based-Purchasing/Downloads/HospVBP_ODF_072711.pdf. Slides 35 to 61 present a comprehensive summary of the “Patient Experience of Care“ domain (HCAHPS) and how the score for this domain is calculated.

Hospital VBP Scoring
The Total Performance Score for Hospital VBP in FY 2013 will have two components: the Clinical Process Domain, which accounts for 70% of the Total Performance Score; and the Patient Experience Domain, which accounts for 30% of the Total Performance Score. The HCAHPS survey is the basis for the Patient Experience Domain.

Eight elements from HCAHPS are used in Hospital VBP (these are termed “dimensions“ in Hospital VBP): the six HCAHPS composites (Communication with Nurses, Communication with Doctors, Staff Responsiveness, Pain Management, Communication about Medicines, and Discharge Information); one new composite that combines the hospital Cleanliness and Quietness survey items; and one Global item (Overall Rating of Hospital). The percentage of a hospital’s patients who chose the most positive, or “top-box,“ response to these HCAHPS items is used in the Patient Experience Domain.

Hospital VBP utilizes HCAHPS scores from two time periods: a Baseline Period and a Performance Period. For FY 2013, the Baseline Period covers patients discharged from July 1, 2009 through March 31, 2010, and the Performance Period from July 1, 2011 through March 31, 2012. Correspondingly, an Improvement and Achievement score for each of the eight HCAHPS dimensions is calculated for each hospital.

The Patient Experience Domain score is comprised of two parts: the HCAHPS Base Score (maximum of 80 points) and the HCAHPS Consistency Points score (maximum of 20 points).

HCAHPS Base Score
Each of the eight HCAHPS dimensions contributes to the HCAHPS Base Score through either the Improvement or Achievement score.

Improvement score (0-9 points) is based on the amount of change in an HCAHPS dimension score from the earlier Baseline period to the later Performance period
Achievement score (0-10 points) is based on the comparison of a hospital's dimension score in the Performance Period to the national median score for that dimension in the Performance Period

For each HCAHPS dimension, the larger of the Improvement or Achievement scores is used to create the HCAHPS Base Score, which ranges from 0 to 80, with each dimension contributing 0 to 10 points.

HCAHPS Consistency Points
The second part of the Patient Experience Domain is the Consistency Points score, which ranges from 0 to 20 points. Consistency Points are designed to target and incentivize improvement in a hospital's lowest performing HCAHPS dimension. Consistency Points are derived from a hospital's lowest scoring HCAHPS dimension as follows:

If a hospital's lowest scoring HCAHPS dimension in the Performance Period is at or above the national median (also known as the ”Achievement Threshold”) of the Baseline Period (which means that all eight dimensions are at or above the median), then the hospital earns the maximum 20 Consistency Points
If a hospital has more than one dimension below the national median, a separate calculation is made to determine which dimension is lowest. That lowest dimension is then used for the calculation of Consistency Points
If a hospital's lowest scoring dimension during the Performance Period is below the national median score of the Baseline Period, then the hospital earns 0 to 19 Consistency Points

Patient Experience Domain Score
The Patient Experience Domain Score is the sum of the HCAHPS Base Score (0 – 80 points) and HCAHPS Consistency Points score (0 – 20 points), thus it can range from 0 to 100 points. As noted earlier, the Patient Experience Domain comprises 30% of the Hospital VBP Total Performance Score.

Please refer to the HCAHPS section of the slide set mentioned above for more details on how Hospital VBP scores are calculated.

Hospital VBP Timeline
There are a number of important dates and events associated with Hospital VBP in 2012, including some occurring soon:

Hospital VBP Dry Run National Provider Call: late February 2012
Hospital VBP Dry Run Reports: issued late February/early March
End of FY 2013 Performance Period: March 31

Other News

HCAHPS Training, both Introductory and Update, will be held March 5-8. Watch our ”What's New” page for the official announcement and registration details
The HCAHPS Project Team's published research is listed in the HCAHPS Bibliography

“What's New?”
We encourage hospitals and their survey vendors to frequently check our “What's New” button to find the latest information on HCAHPS, such as upcoming data submission deadlines. We also invite you to share the material presented on HCAHPS Executive Insight, but when you share or reproduce this material, please include the following citation:

HCAHPS Executive Insight, January 2012. hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Month, Date, Year the page was accessed. http://www.hcahpsonline.org/Executive_Insight/.

Thanks for visiting HCAHPS Executive Insight. Comments or suggestions for HCAHPS Executive Insight should be directed to us, by email, at hcahps@azqio.sdps.org.

Bill Lehrman and Liz Goldstein, Co-editors

Division of Consumer Assessment & Plan Performance
Centers for Medicare & Medicaid Services (CMS)




	Welcome January 2012 Welcome back to HCAHPS Executive Insight, the gold button on the HCAHPS On-Line Web Site, www.hcahpsonline.org. In January, the Centers for Medicare & Medicaid Services (CMS) refreshed the HCAHPS results on the Hospital Compare Web site (www.hospitalcompare.hhs.gov) The new HCAHPS scores are based on patients discharged between April 2010 and March 2011. Highlights HCAHPS data for First Quarter 2010 were rolled off of Hospital Compare, while First Quarter 2011 results were rolled on The January 2012 scores are based on more than 2.7 million completed surveys from 3,837 hospitals Put differently, on average, every day more than 25,000 patients are surveyed about their hospital experience; every day more than 7,500 patients complete the HCAHPS survey News and Notes from the HCAHPS Project Team HCAHPS and Hospital Value-Based Purchasing: A Brief Overview In this edition of HCAHPS Executive Insight we present an overview of the role HCAHPS scores play in the new Hospital Value-Based Purchasing program. In the future we will move this content, updated as needed, to a new section of the HCAHPS On-Line Web site, “HCAHPS and Hospital VBP.“ We hope that www.hcahpsonline.org will become a handy resource for hospitals, survey vendors and others interested in HCAHPS’s role in the Hospital VBP program. Briefly, Hospital VBP links a portion of Inpatient Prospective Payment System (IPPS) hospitals' payment from CMS to performance on a set of quality measures. The Hospital VBP program was first presented in a Report to Congress in November 2007 and was established by the Patient Protection and Affordable Care Act of 2010. Several Final Rules issued in 2011 set out the parameters of the program for FY 2013 and FY 2014. For more information about Hospital VBP, please visit CMS' dedicated Web site, http://www.cms.gov/Hospital-Value-Based-Purchasing/. The slide set from CMS' July 2011 “Open Door Forum“ on the Hospital VBP program can be found at http://www.cms.gov/Hospital-Value-Based-Purchasing/Downloads/HospVBP_ODF_072711.pdf. Slides 35 to 61 present a comprehensive summary of the “Patient Experience of Care“ domain (HCAHPS) and how the score for this domain is calculated. Hospital VBP Scoring The Total Performance Score for Hospital VBP in FY 2013 will have two components: the Clinical Process Domain, which accounts for 70% of the Total Performance Score; and the Patient Experience Domain, which accounts for 30% of the Total Performance Score. The HCAHPS survey is the basis for the Patient Experience Domain. Eight elements from HCAHPS are used in Hospital VBP (these are termed “dimensions“ in Hospital VBP): the six HCAHPS composites (Communication with Nurses, Communication with Doctors, Staff Responsiveness, Pain Management, Communication about Medicines, and Discharge Information); one new composite that combines the hospital Cleanliness and Quietness survey items; and one Global item (Overall Rating of Hospital). The percentage of a hospital’s patients who chose the most positive, or “top-box,“ response to these HCAHPS items is used in the Patient Experience Domain. Hospital VBP utilizes HCAHPS scores from two time periods: a Baseline Period and a Performance Period. For FY 2013, the Baseline Period covers patients discharged from July 1, 2009 through March 31, 2010, and the Performance Period from July 1, 2011 through March 31, 2012. Correspondingly, an Improvement and Achievement score for each of the eight HCAHPS dimensions is calculated for each hospital. The Patient Experience Domain score is comprised of two parts: the HCAHPS Base Score (maximum of 80 points) and the HCAHPS Consistency Points score (maximum of 20 points). HCAHPS Base Score Each of the eight HCAHPS dimensions contributes to the HCAHPS Base Score through either the Improvement or Achievement score. Improvement score (0-9 points) is based on the amount of change in an HCAHPS dimension score from the earlier Baseline period to the later Performance period Achievement score (0-10 points) is based on the comparison of a hospital's dimension score in the Performance Period to the national median score for that dimension in the Performance Period For each HCAHPS dimension, the larger of the Improvement or Achievement scores is used to create the HCAHPS Base Score, which ranges from 0 to 80, with each dimension contributing 0 to 10 points. HCAHPS Consistency Points The second part of the Patient Experience Domain is the Consistency Points score, which ranges from 0 to 20 points. Consistency Points are designed to target and incentivize improvement in a hospital's lowest performing HCAHPS dimension. Consistency Points are derived from a hospital's lowest scoring HCAHPS dimension as follows: If a hospital's lowest scoring HCAHPS dimension in the Performance Period is at or above the national median (also known as the ”Achievement Threshold”) of the Baseline Period (which means that all eight dimensions are at or above the median), then the hospital earns the maximum 20 Consistency Points If a hospital has more than one dimension below the national median, a separate calculation is made to determine which dimension is lowest. That lowest dimension is then used for the calculation of Consistency Points If a hospital's lowest scoring dimension during the Performance Period is below the national median score of the Baseline Period, then the hospital earns 0 to 19 Consistency Points Patient Experience Domain Score The Patient Experience Domain Score is the sum of the HCAHPS Base Score (0 – 80 points) and HCAHPS Consistency Points score (0 – 20 points), thus it can range from 0 to 100 points. As noted earlier, the Patient Experience Domain comprises 30% of the Hospital VBP Total Performance Score. Please refer to the HCAHPS section of the slide set mentioned above for more details on how Hospital VBP scores are calculated. Hospital VBP Timeline There are a number of important dates and events associated with Hospital VBP in 2012, including some occurring soon: Hospital VBP Dry Run National Provider Call: late February 2012 Hospital VBP Dry Run Reports: issued late February/early March End of FY 2013 Performance Period: March 31 Other News HCAHPS Training, both Introductory and Update, will be held March 5-8. Watch our ”What's New” page for the official announcement and registration details The HCAHPS Project Team's published research is listed in the HCAHPS Bibliography “What's New?” We encourage hospitals and their survey vendors to frequently check our “What's New” button to find the latest information on HCAHPS, such as upcoming data submission deadlines. We also invite you to share the material presented on HCAHPS Executive Insight, but when you share or reproduce this material, please include the following citation: HCAHPS Executive Insight, January 2012. hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Month, Date, Year the page was accessed. http://www.hcahpsonline.org/Executive_Insight/. Thanks for visiting HCAHPS Executive Insight. Comments or suggestions for HCAHPS Executive Insight should be directed to us, by email, at hcahps@azqio.sdps.org. Bill Lehrman and Liz Goldstein, Co-editors Division of Consumer Assessment & Plan Performance Centers for Medicare & Medicaid Services (CMS)