CMS announced a new hospital-payment system called value-based purchasing (VBP) in October 2012. The patient experience of care domain in VBP is based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and encompasses eight aspects of consumer experiences in the healthcare system: 1) communication with nurses, 2) communication with doctors, 3) responsiveness of hospital staff, 4) pain management, 5) cleanliness and quietness of the hospital environment, 6) communication about medicines, 7) discharge information, and 8) the overall rating of hospital.
Press-Ganey surveys of patient satisfaction are currently used by almost half of all hospitals in the United States, with many questions being directed at specific components of the HCAHPS survey. There is increasing hospital awareness of customer satisfaction with implementation of VBP, and some states have linked physician salaries to patient satisfaction. There also appears to be a trend amongst emergency physician groups that links compensation and incentive payments to patient satisfaction scores, but few data exploring the effect of this trend are available.
Fast Tracking Programs
ED fast track is a designated area where lower acuity patients are rapidly seen in the ED. “ED fast track programs have become more prevalent in recent years,” says Calvin Hwang, MD. Some studies indicate that nearly 80% of EDs in the U.S. currently incorporate some type of fast track area. In a study published in the Western Journal of Emergency Medicine, Dr. Hwang and colleagues examined if implementing an ED fast track had an effect on Press-Ganey scores of patient satisfaction.
For the study, Dr. Hwang and colleagues analyzed data from respondents to a Press-Ganey questionnaire for 1 year both before and after a fast track program was implemented in the ED. Patients in the pre- and post-fast track cohorts represented approximately 9% of the overall ED volume during each time period assessed in the study. “Across seven categories that were selected for analysis, we observed statistically significant improvements in patient satisfaction after implementing an ED fast track area,” Dr. Hwang says (Figure 1 and Figure 2).
Results showed that patient satisfaction with wait times increased from 68% to 88%, from 90% to 95% for doctor courtesy, and from 87% to 95% for nurse courtesy. In addition, patient satisfaction rates rose from 66% to 83% for staying informed about delays and from 82% to 91% for staff caring. Furthermore, patient satisfaction rates increased from 79% to 87% for pain control and from 81% to 90% for the likelihood to recommend the hospital to others.
According to Dr. Hwang, patient satisfaction surveys can be a valuable tool to improve the patient experience and overall operational performance, especially as healthcare providers face more pressure to manage costs and do more with less. “Collecting patient satisfaction data helps provide an understanding of potential opportunities for improvement,” Dr. Hwang says. “Understanding and acting on patient satisfaction results can support hospitals as they prepare for new quality measures that are expected to be put in place as a reimbursable metric associated with ED visits.”
The development of an ED fast track enabled the research team to improve the value of care delivered to patients in the ED despite experiencing the operational challenges associated with a growing patient population and space constraints that EDs face throughout the country. Dr. Hwang and colleagues concluded that fast track programs can potentially lead to quicker service, increases in capacity, and improved patient satisfaction.
The study noted that a number of patient-centered metrics outside control of the ED worsened in the post-fast track implementation period, including a 4% increase in overall volume and a 37% increase in hours spent boarding. Despite these findings—which typically worsen patient satisfaction scores—the authors found that implementing an ED fast track was associated with improved overall patient satisfaction scores in the study. Dr. Hwang notes that other patient care metrics for the entire department may be more important to patients, such as reductions in length of stay and door-to-physician time. It is also possible that EDs can better optimize patient flow and resource use because fast tracks allow for more rapid turnover of low acuity patients.
“Our study is timely considering that CMS is mandating the use of patient surveys to decide on how to allocate dollars in federal funding for EDs,” says Dr. Hwang. “If EDs do not meet performance and quality standards, the consequences can be costly. Implementation of ED fast track programs may play an important role in improving ED performance on CMS benchmarks of quality, especially with regard to lower acuity patients.”
Hwang CE, Lipman GS, Kane M. Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. West J Emerg Med. 2015;16:34-38. Available at: http://westjem.com/articles/effect-of-an-emergency-department-fast-track-on-press-ganey-patient-satisfaction-scores.html.
Dinh M, Enright N, Walker A, et al. Determinants of patient satisfaction in an Australian emergency department fast-track setting. Emerg Med J. 2012;30:824-827.
Liu S, Hamedani A, Brown D, et al. Established and novel initiatives to reduce crowding in emergency departments. West J Emerg Med. 2013;14:85-89.
Considine J, Kropman M, Kelly E, et al. Effect of emergency department fast track on emergency department length of stay: a case–control study. Emerg Med J. 2008;25:815-819.