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Panelists Urge Focus on Patient Satisfaction as Part of Measuring Process

By Cheyenne Hopkins, CQ Staff

December 4, 2006 -- What patients think about the medical care they receive is as important as other measurements of a health care provider's performance, according to speakers at a Monday forum hosted by the Alliance for Health Reform and The Commonwealth Fund.

Ways to measure "patient-centered care" include how much patients are involved in their medical treatment, how well that patient care is coordinated among providers, routine feedback to hospitals, clinical information systems that support high-quality care, and publicly available information on patient-centered care, speakers said.

"We need to make patient-centered care a central part of pay-for-performance," said Karen Davis, president of The Commonwealth Fund.

Davis said that patient-centered care measures should be included in any effort to tie Medicare payments to the quality of care delivered, or pay for performance. She warned it was important to not get too focused on pay-for-performance care and not leave patient-centered care behind.

A move to pay for performance in hospitals began with Medicare tying payment to hospitals' reporting on performance quality, a provision included in the Medicare drug law (PL 108-173). The idea was that payment will ultimately be based on quality performance standards or at least show some improvement on those standards.

In September, the Centers for Medicare and Medicaid Services (CMS) required that patients' experiences with care be added to the hospital measurement requirements. The rule also increased the penalty for not reporting.

Separately, a demonstration project started in 2003 between CMS and Premier Inc., an alliance of not-for-profit hospitals, is testing the merits of "value-based purchasing," which links payment to quality of care. The budget savings law (PL 109-171) signed in February requires CMS to develop a plan to enact value-based purchasing beginning in 2009. An analysis conducted by Premier in September found that costs, complications, and deaths associated with hospital stays could be reduced if hospitals followed certain steps to ensure patients received high-quality care.

There is some evidence that patient-centered care correlates with health outcome, Davis said. A report by the Joint Commission Journal on Quality Improvement found that patients were more likely to suffer fewer complications and death if they had received patient-centered care.

A current measurement of patient satisfaction is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, conducted by the Agency for Health Care Research and Quality. It's a public-private initiative to develop standardized surveys of patients' experiences with ambulatory and facility-level care. The program has been adopted by the National Community for Quality Assurance, Medicare, Medicaid, the U.S. Office of Personnel Management, and the Defense Department. Approximately 138 million Americans are in health plans for which CAHPS data are collected.

Charles Darby, co-project officer on the CAHPS survey, said the major challenge is relaying survey results to patients. Next summer, CAHPS will begin the next phase of the survey, which will have a greater focus on the use of the surveys for quality improvement and public reporting.

Individual states also are implementing programs that focus on patients' view of the medical care they received. For example, in 1995 Massachusetts created the Massachusetts Health Quality Partners (MHQP), an independent agency that looks at the quality of health care in Massachusetts through the use of clinical data and the patient experience. In 1998, the agency was the first in the nation to release a statewide hospital survey of patient experiences. Its most recent report on primary care physicians was released in March.

The Massachusetts survey found mixed results from patients on their doctors' performance. Eighty-three percent of practices statewide achieved a score of at least 90 points on communication measure. However, more than one-third of adult patients report that their personal doctor did not always seem to know all the important information about their medical history, and 40 percent of patients said their primary care physician was not always informed or up to date about care they received from specialists.

Massachusetts State Web sites, health plan sites, and several provider organizations have begun providing links to the MHQP reports. Melinda Karp, director of programs for MHQP, said she sees the reports being used later for physician certification, linked by employers, and pay-for-performance programs.

"We've got to get [patients] more interested in the data," Karp said. "That is the next step."

While electronic medical records are a valuable tool but that alone will not drive the improvements needed, she said.

Davis said while patients do not base their health care on performance standards now, patient-centered care can be a "powerful force in the future."

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