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9/21/2011

Leveraging HHCAHPS Results to Improve Patient Care and Increase Revenue

Presented by:

Bill Bassett

Vice President Home Health Care

Today's Discussion

· Describe what HHCAHPS is measuring · Review regulatory updates · Discuss national benchmarks · Identify strengths and opportunities for improvement · Discuss how to improve satisfaction scores

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HHCAHPS Program Highlights

· Final Rule HH PPS

­ Medicare-certified agencies ­ Updates in HH PPS CY2012

· Mandates use of survey vendor

­ Collect and submit data on agency's behalf ­ Submitted patient-level data to CMS

· Medicare and/or Medicaid patients

­ For CMS data reporting

· Results publically reported

Patient Eligibility Criteria

· Monthly random sample of patients:

­ Medicare and/or Medicaid (for minimum compliance) ­ At least 18 yrs ­ Are not deceased when sample frame is drawn ­ No maternity care ­ Not receiving hospice ­ Not recently surveyed (during 5 months prior) ­ Not requested "no p q publicity status" y

­ Current or discharged who had at least one skilled

visit during last 30 days ­ At least two skilled visits in 60 day look back period

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Participation Exemptions

· Very small HHAs may submit a Participation Exemption

Request form ­ Must have served 59 or fewer patients who meet survey eligibility criteria ­ Submit online form to CMS · Exemption is for 1 year only ­ HHAs must count survey-eligible patients and submit that count to CMS (submit a Participation Exemption Request form) every year.

State patient exclusion - clarification

· A new exclusion to be made by HHAs:

­ If a state has special privacy laws or regulations that require special consent for release of information concerning certain categories of patients, those patients should be excluded from the patient files sent to the HHCAHPS Survey vendor

· Typically these patients are those with:

­ HIV ­ Al h l or substance abuse Alcohol b t b ­ Mental health conditions

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Definition of a skilled visit - clarification

· For purposes of this survey, the basis for a skilled home

health visit is the classification of the agency employee who visited the patient, not the reason f the visit for

­ ­ ­ ­ The visit must be made by a RN or a LPN PT or physical therapist assistant OT or occupational therapist assistant ST or speech therapist assistant

· Skilled visits do not include visits by ­ Social workers ­ Home health or personal care aides, or nursing aides

Look back Period - clarification

· The look back period is the sample month and the

calendar month preceding the sample month. · The patient must have at least one skilled visit in the sample month and two skilled visits during the look back period · If the patient has two skilled visits during the look back period but none in the sample month, that patient is not eligible for the survey. survey

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HHCAHPS Survey Cycle

10th of Month · Patient data sent to Deyta · Data cleansing · Patient eligibility · Random sampling

21st of Month · 1st wave of surveys mailed to patient

3 weeks later · 2nd wave of surveys mailed to nonresponders

3 weeks later · All surveys must be returned · Results processed

Survey Process - Reporting

· De-identified results · Monthly file · CMS required data

Reporting to CMS

Reporting to Clients

· Identified results · Public reporting dashboards · 15th of the month

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Quantity to Survey Quantity to Survey

HHAs should target 300 completed surveys per year

· Automatically adjust the random sample size to generate the · HHAs should target 300 completed surveys per year · Smooth inflow of completed surveys during course of the year

­ ­ new ­

Smooth inflow of completed surveys during course of the year Monthly sampling protocols monthly requirement Automatically adjust the random sample size to generate the new monthly requirement

· If patient count will not reach 300, then survey 100% of patients

· HHAs should target 300 completed surveys per year

If patient count will not reach 300, then survey 100% of · If patient count will not reach 300, then survey 100% of patients patients

­ Smooth inflow of completed surveys during course of the year ­ Monthly sampling protocols ­ Automatically adjust the random sample size to generate the new monthly requirement

A Completed Survey

· Definition of a Completed Survey ­ A survey is considered to be "complete" if at least 50 % of the 1 11, questions applicable to all sample members (Questions 1­11 15­21, and 24­25) are answered. ­ Skip pattern and "About You" items are not included in this calculation

Definition of a C f f Completed S Survey

· A survey is considered to be "complete" if at least 50 % of the

questions applicable to all sample members (Questions 1­11, 1­ 15­ 15­21, and 24­25) are answered. 24­ · Skip pattern and "About You" items are not included in this calculation

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Patient Confidentiality

· 3/9/10 Addendum to P&G Manual Chapter VIII

"...CMS has decided to allow survey vendors to share information that could link an HHCAHPS respondent to his or her answers under one condition only:

­ survey vendors can share a respondent's survey responses linked to his or her name with the client HHA only if the patient (hereafter referred to in this document as "the respondent) gives the survey vendor permission to do so."

Patient informing - clarification

· HHAs may inform all patients during the intake phase or in the

agency's admission materials that they may be contacted and asked to respond to a patient experience survey. · It is not acceptable to:

­ Send letters / contact patients to let them know that they have been selected for the HHCAHPS and that their responses would be appreciated. ­ Nor is it acceptable for home health agency provider staff to engage in discussions with their patients about the HHCAHPS Survey ­ Contact patients in advance to ask them if they want to participate in the survey

· For patients currently receiving care, including long-term

patients, it is appropriate to inform them during their next scheduled assessment that they may be asked to respond to a patient experience survey.

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Follow-up with HHCAHPS Survey Respondents

HHCAHPS Survey respondents have the right to answer the questions in the HHCAHPS Survey based on their own perception of the care that they receive freely and without fear of later repercussions or threat threat. · Home health agencies are not permitted to contact HHCAHPS Survey respondents to ask them about their answers to the HHCAHPS Survey unless one of two conditions applies: ­ The respondent reports that there have been instances of negligence, abuse, or harm to the patient; and/or ­ The respondent reports that the agency's home health care provider specifically did something that the respondent perceives as jeopardizing the patient's health and/or well-being. · An agency cannot ask a patient for the reasons he or she responded to HHCAHPS Survey questions in a certain way · HHAs may use survey responses linked to information that identifies a patient to aid in the agency's quality improvement efforts, including identifying a specific home care provider who may not be performing as expected

·

HHCAHPS 2011 National Report Card

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HHCAHPS Public Reporting

· 5 measures publically reported

­ 2 global questions ­ 3 composite measures · 4-7 questions centered around specific topics · Reported results will be based on a four quarters of data ­ Results will be a rolling 4 quarters, updated each quarter

Release of Public Reporting - Update

· The HHCAHPS Public Reporting will not be released until early 2012. ·

·

· ·

This is a delay in the stated delivery of July 2011 The Centers for Medicare & Medicare Services (CMS) expects to begin publicly reporting results from the Home Health Care CAHPS (HHCAHPS) Survey in early calendar year 2012. As noted in the HHCAHPS Survey Protocols and Guidelines Manual, Version 3.0, survey results for each participating home health agency (HHA) will first be reported after the HHA submits HHCAHPS Survey data for 4 calendar year quarters. Publicly reported results will always reflect the most recent 4 quarters of data submitted for an HHA. CMS and the HHCAHPS Coordination Team will provide more information about public reporting in fall 2011.

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What is HHCAHPS Measuring?

· Perception of the clinicians' ability to deliver

­ ­ ­ ­ ­ ­ ­ Details on home care services, visits and timing Safety and falls prevention Medication instructions Pain management Sensitivity to patient needs Courtesy and respect Listening

· Perception of the HHA's responsiveness

­ Inquiries for assistance ­ Time to respond

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HHCAHPS National Report Card

Public Reporting Questions Deyta National Benchmark Q2 2011 85.5% Q2 2011 Grade

Q20: What number (0-10)...rate your care from this agency? (% 9 or 10) * Q25: Would you recommend this agency to family...care? (% Definitely Yes) *

79.5%

HHCAHPS Questions: Q20: Using any number from 0 to 10, where 0 is the worst home health care possible 10 and 10 is the best home health care possible, what number would you use to rate your care from this agency's home health? Q25: Would you recommend this agency to your family or friends if they needed home health care?

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HHCAHPS National Report Card

Public Reporting Questions Deyta National Benchmark Q2 2011 85.5% Q2 2011 Grade

Q20: What number (0-10)...rate your care from this agency? (% 9 or 10) * Q25: Would you recommend this agency to family...care? (% Definitely Yes) * Care of Patients Composite

79.5% 88.7% 85.7%

Communication Between Providers and Patients Composite

Specific Care Issues Composite

83.1%

20: What number (010)...rate your care from this agency? (% 9 or 10)

90.0%

87.5% 87 5% 87.2%

85.0%

85.5%

80.0% Q4 2010 Q1 2011 Q2 2011

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85.0%

25: Would you recommend this agency to family/ friends? (% Definitely yes)

81.6%

81.5%

80.0% 79.5%

75.0% Q4 2010 Q1 2011 Q2 2011

Care of Patients Composite Score

89.6% 89.4% 89.0% 88.7%

87.0%

85.0% Q4 2010 Q1 2011 Q2 2011

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Communications Between Providers and Patients Composite

90.0%

86.4%

86.4% 85.7%

85.0%

80.0% Q4 2010 Q1 2011 Q2 2011

Specific Care Issues Composite

85.0%

84.5%

84.0%

83 5% 83.5% 83.3% 83.0% 83.4% 83.1%

82.5%

82.0%

81.5%

81.0%

80.5%

80.0% Q4 2010 Q1 2011 Q2 2011

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Care of Patients Composite

100.0%

95.0% 94.9% 90.0% 92.0% 91.8% 91.3% 94.7% 94.2%

95.3%

95.1%

95.1%

85.0%

80.0%

75.0%

76.4%

76.2% 74.3%

70.0%

65.0%

60.0% 9: Did providers seem 16: How often did providers treat 19: How often did providers treat 24: Did you have any problems informed/uptodate on care or you as gently as possible? (% you with courtesy and respect? (% with the care you got? (% No) treatment? (% Always) Always) Always) Q4 2010 Q1 2011 Q2 2011

Communications Between Providers and Patients Composite

100.0% 95.0%

96.6% 96.5% 96.5%

90.0%

91.6% 90.7% 91.0%

85.0% 85 0%

84.9% 84.7% 83.2%

86.3% 86.2% 86 3% 86 2%

85.1%

80.0%

81.3% 81.1% 79.4% 78.7% 78.9% 78.2%

75.0%

70.0%

65.0%

60.0% 2: Did someone tell you what care and services you would get? (% Yes) 15: How often providers informed you when arrive at your home? (% Always) 17: How often did providers explain things...easy to understand? (% Always) Q4 2010 Q1 2011 18: How often did 22: When you 23: How long did it providers from listen contacted office did take to get the carefully to you? (% you get the help/advice you Always) help/advice needed? needed? (% Same Day) (% Yes) Q2 2011

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9/21/2011

Specific Care Issues Composite

95.0%

90.0%

90.4% 90.5% 90.6% 86.7% 87.0% 86.5%

90.3%

89.7% 89.6% 86.6% 87.2% 86.3%

85.0%

80.0%

81.9% 81.5% 81.9% 79.2% 79.4% 78.8%

75.0%

70.0%

68.1% 68.2% 67.8%

65.0%

60.0% 60 0% 3: Did someone talk 4: Did someone talk 5: Did someone ask 10: Did you and a 12: Did providers 13: Did you and a 14: Did providers about how to set up about all the Rx and to see all the Rx and home health talk about purpose home health talk about side your home and OTC medicines your OTC medicines your provider talk about for new/changed Rx provider talk about effects of these move safely? (% Yes) taking? (% Yes) taking? (% Yes) pain? (%Yes) medicines? (%Yes) when to take meds? medicines? (%Yes) (%Yes) Q4 2010 Q1 2011 Q2 2011

5 Steps to Obtaining the A

Improving HHCAHPS Scores

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5 Steps to Obtaining the A

Assess Perception

Review and Refine

Determine Best/Worst Practices

Improvement Plan

Replicate Best

Step 1: Assess Overall "Perception"

·

Look at all the results of all 19 questions ­ Break them into the High and Low scores g ­ Consider dramatic trends changes too

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The A's - National HHCAHPS

100.00% 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00%

96.59%

95.25%

94.90% 91.96% 90.73% 90.38% 90.30%

Q4 2010 Q4 2010

2: Did someone tell you what care and services you would get? (% Yes) 24: Did you have any problems with the care you got? (% No) 19: How often did providers treat you with courtesy and respect? (% Always) 16: How often did providers treat you as gently as possible? (% Always) 22: When you contacted office did you get the help/advice needed? (% Yes) 4: Did someone talk about all the Rx and OTC medicines your taking? (% Yes) 10: Did you and a home health provider talk about pain? (%Yes)

The Low Scores (C&D)- National HHCAHPS

79.00%

79.22% 78.66%

77.00%

76.40%

75.00%

73.00%

71.00%

69.00%

68.12% 68 12%

67.00%

65.00% Q4 2010

13: Did you and a home health provider talk about when to take meds? (%Yes) 23: How long did it take to get the help/advice you needed? (% Same Day) 9: Did providers seem informed/uptodate on care or treatment? (% Always) 14: Did providers talk about side effects of these medicines? (%Yes)

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Step 2: Determine Best & Worst Practices

Agency Best Practices

Question 2: Inform Care/Services Our HHA does well because: · Well defined process · Use of checklist to follow · Scripted dialog · Materials to hand out to patient · Good training · Experienced team

· What best practices lead

to these high scores? ­P People l ­ Processes ­ Policies ­ Training · How to maintain the A's?

Determine Worst Practices

· What contributed to the low

Ever Hear These Comments?

scores · Are their commonalties?

­ ­ ­ ­ ­ Staff issues Training issues Communication issues Visit policies Internal procedures

"Really? I didn't know that?"

"That's not my job."

"I'm supposed to do that for every patient?" yp "When did we start doing it that way?"

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Step 3: Replicate the Best

· Look for similarity in the questions that will allow you to apply your

Best practices to your Worst practices

Worst Practices Inexperienced team Weak training Procedure control/tracking Confusion on what to say Best Practices Mentoring, precepting, coaching Internal/external certification programs Checklist Develop scripts

Step 4: Improvement Plan

· Create a Satisfaction Improvement Plan

­ ­ ­ ­

Keep it simple - only work on a bit at a time Identify specific programs needed Define goals and set improvement expectations Map out a timeline for each piece needed

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Step 5: Review and Refine

· Review and share the results

Assess Perception

with the team regularly ­ Embrace transparency ­ Use Comments - stories · Refine existing plan · Move forward with next measures for improvement

Review and Refine

Determine Best/ Worst Practices

Improvement Plan

Replicate Best

Bill Bassett

Vice President Home Health Care [email protected] bb [email protected] t P: 206.910.0428

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