CAHPS: Understanding How Patients Perceive Their Care Experience

Calling a patient a customer can be off-putting for many of us. A patient seeks treatment from a physician for a medical condition and the physician and his or her staff work to provide that care using their unique expertise and judgment. Patients are not customers, for reasons described by Shirie Leng, MD. Yet patients expect a positive experience with their care teams and physicians. They want to be treated with respect, to be involved in their care through shared decision making and to receive the right care as expediently as possible for their condition. And they do have a choice of whom they wish to see for their care. In this way, their patient status provides them with a unique position as a healthcare consumer.

In other industries, the experience that you have as a consumer when you use a product or a service is incredibly important. Companies are creating ways to make those experiences unique and use survey tools to measure their success. For example, I recently took one of my cars to an auto dealership for a service call. The service area offered Wi-Fi, coffee, pastries, a large-screen TV, copies of the morning newspaper and a semi-private bank of phones. After my car was serviced, Jon, the service associate, went through a list of items with me that were checked, fixed or needed attention in the future. Upon paying for the service, I received a five-question evaluation form with an emphasis on setting, communication, time and efficient service plus a request to also take a telephonic or email survey.

Patient care is not the same as car care. Yet if you ask yourself what you would want if you were a patient, you might answer that you want a great experience with your care team, fantastic communication with your doctor, an opportunity to ask questions and reach decisions about a treatment plan that works for you and the knowledge that the most appropriate medicine and the most appropriate care would be combined to help you with your condition. This is the voice of the patient. We have the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to better help us understand this voice of the patient. With these surveys the federal government measures the experience of care for patients. The principles underlying CAHPS recognize that the people who received the care are the best ones to comment about it and they know what is important to them.

CAHPS Overview

CAHPS started in U.S. healthcare in 1995 as a way to assess health plans. In 2006, CAHPS, with involvement from the Centers for Medicare & Medicaid Services (CMS), expanded to include hospitals (HCAHPS). There is now a family of CAHPS surveys, including the original CAHPS Health Plan Survey, HCAHPS, CAHPS Nursing Home Survey, CAHPS Clinician and Group Survey, ECHO Survey for behavioral health services, Outpatient and Ambulatory Surgery CAHPS and In-Center Hemodialysis (ICH) CAHPS. To make CAHPS more valid, the Agency for Healthcare Research and Quality (AHRQ) and CMS recognized standardized surveys would more accurately reflect patient experience in each of these areas.

In-Center Hemodialysis CAHPS

ICH CAHPS measures how patients with end stage renal disease (ESRD) who receive in-center hemodialysis perceive their care. ICH CAHPS evaluates:

• How the nephrologist communicated and whether he or she was caring
• How the staff communicated and whether they were caring
• What the patient perceived about the dialysis facility
• Whether the patient received information about all treatment options
• Whether the patient’s problems, if any, were handled well

Unlike my experience at the auto dealer where I was asked to complete a survey right there, ICH CAHPS is provided by an outside vendor to patients by mail, by phone or in a mixed form of both. It cannot be administered by a facility staff person or in the dialysis facility. CMS also administers surveys to in-center hemodialysis patients twice a year and only in facilities that have 30 or more survey-eligible patients during a calendar year.

Understanding patient experience is important enough in the eyes of CMS to make ICH CAHPS one of the parameters in the ESRD Quality Incentive Program (QIP). The QIP is a CMS program that links a portion of payment to facility performance on quality measures. ICH CAHPS, like other CAHPS surveys, elevates the perspective of the patient as a healthcare consumer into a core performance measure for CMS payment programs. Still, it is not perfect. ICH CAHPS is reported out at the facility level so specific areas of performance within facilities are hard to tease out. The survey is estimated to take 18 minutes to complete 62 questions. This is more than a quick online survey. The time lag from survey to reporting does not allow for real-time feedback. Telephonic surveys are only available in English and Spanish, although mail surveys also include Chinese and Samoan. This still doesn’t cover every primary language for our patients. Response rates are variable across the country. Finally, the survey is not offered to home dialysis patients, who are ESRD Medicare beneficiaries too. Despite these concerns, having a standardized survey for the vast majority of our patients is a tremendous resource for our kidney care community.

In today’s culture we need to hear the voice of the patient in a way that allows us to help improve their care experience. ICH CAHPS focuses on what you would want when you need clinical care:

• Clear communication in a language that you can understand
• Respect for who you are
• A place of care that you can trust
• To be seen as special by the person taking care of you
• To help you when you have a problem, or anticipate a problem and help prevent it

Can we do all of those things with the care we deliver and provide an amazing experience? I watched our teammates at our own center, Stony Island Dialysis on the south side of Chicago, deliver care with amazing affability; provide coaching with words that made sense to patients; perform exceptional, proactive problem-solving; and maintain an attitude that combined the professional with the personal. ICH CAHPS helps us figure out where and how we can make our care experience better for our patients through our patients’ eyes.