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Survey providers: St. Peter's and other NJ hospitals adapt to service surveys that affect reimbursement

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Lisa Drumbore, vice president and chief experience officer, and Garrick Stoldt, CFO, Saint Peter’s University Hospital in New Brunswick.
Lisa Drumbore, vice president and chief experience officer, and Garrick Stoldt, CFO, Saint Peter’s University Hospital in New Brunswick. - ()

In an effort to maximize inpatient reimbursements from CMS (Centers for Medicare & Medicaid Services), New Jersey hospitals are focusing on the service component of care as much as they are trying to exceed expectations on the clinical side.

CMS requires hospitals to collect information from at least 300 patients each year using the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS). The HCAHPS, a national, publicly reported survey of patients’ opinions of their inpatient experiences, is used to determine CMS reimbursement levels for hospitals throughout the country.

As of this year, hospitals will either lose or gain up to 2 percent of reimbursement dollars, based on the results of the HCAHPS. The rate was 1.5 percent in each of the past two years. With so much revenue at stake, New Jersey hospitals have no choice but to strive to improve the patient experience, a move that will no doubt have a major impact on their HCAHPS scores.

CMS uses the HCAHPS to collect data on patient perspectives in 27 categories, specifically topics that are important to consumers. Questions range from pain management to provider communication to the cleanliness of the hospital. The results of these surveys create incentives for hospitals to improve quality of care and provide a new level of transparency in return for public investment.

CMS is focused on inpatient hospital experiences through its Value-Based Purchasing program (VBP), but the agency announced last July that payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System are coming in 2018.

While 75 percent of CMS’ value-based purchasing, the system used to calculate reimbursement percentages, is based on how well hospitals meet standardized inpatient clinical care metrics (mortality rates, minimum infection rates), the remaining 25 percent is based on patient perspectives of how hospitals provide that care. Therefore, about a third of Medicare reimbursement dollars for hospitals are based on a patient’s personal experience with doctors, nurses, orderlies, food servers — even the valet.

It is worth noting that managed care companies, including Aetna and Unitedhealthcare, set quality standards metrics and base annual bonuses, rather than reimbursements, on a hospital’s ability to meet or exceed those metrics.

The expectation, of course, is that a hospital is doing everything possible to provide the highest level of quality medical care. The wild card has always been, and will always be, public perception. Patients’ and family members’ opinions of services received is the part of the equation many hospital administrators are focused on. They know, in the court of public opinion, one bad review is worth far more than several good ones.

That being said, there is more than one reason to encourage patient satisfaction. “Patient and family engagement leads to happier patients and ultimately better medical results,” said Melinda Caliendo, public relations manager at the New Jersey Hospital Association.

“The NJHA is active in coming up with new ways to educate members to encourage them to develop patient and family advisory committees and other ways to include patients in hospital governance so they have a larger voice in the healthcare community,” Caliendo said.

For all these reasons, it makes sense that New Jersey hospitals, including Saint Peter’s University Hospital in New Brunswick, place heavy emphasis on soft skills, the service side of the business.

A closer look ... Saint Peter’s University Hospital

New Brunswick-based Saint Peter’s University Hospital, a member of Saint Peter’s Healthcare System, is a 478-bed acute care teaching hospital sponsored by the Roman Catholic Diocese of Metuchen. The non-profit facility treats more than 30,000 inpatients and more than 200,000 outpatients yearly.

Saint Peter’s was recently recognized as a five-time Magnet hospital by the American Nurses Credentialing Center, one of just five hospitals in the world to receive the honor.

With fluctuating CMS reimbursements over the past several years, Saint Peter’s is understandably focused on improving patient satisfaction.

In 2015 and 2016, Saint Peter’s HCAHPS scores were down. In fact, CMS reimbursements were reduced by $63,000 and $41,000 respectively. In 2017, Saint Peter’s reimbursement data, announced on Sept. 30, 2017, is up $44,000, based on a 2017 Medicare inpatient payment of $53 million, said Garrick Stoldt, chief financial officer at St. Peter’s University Hospital.

The projected fiscal 2018 reimbursement, based on current case mix intensity and volume, is $47,000.

“It’s important to note that these reimbursements are based on a three-year rolling average of HCAHPS scores,” Stoldt said. “I believe the reimbursement percentage is actually a false indicator of how we are doing. A facility’s quality today could be at its highest level but the three-year average shows a different calculation. The truth is, what happened three years ago in healthcare is ancient history today.”

On the other hand, he said, Saint Peter’s Leapfrog Hospital Safety Grade has been an “A,” three times running. Since the scores are issued twice a year, Stoldt maintained this is a more appropriate assessment of the hospital’s performance — though it has no impact on reimbursement dollars. The Leapfrog grade is set to be released at the end of this month; Stoldt said he is “hopeful” about his facility’s ongoing high marks.

Lisa Drumbore, vice president and chief experience officer at Saint Peter’s, said providing the highest level of service is “critical” to the hospital’s mission.

Drumbore said her team is hyper-vigilant when it comes to new employee orientation and a consistent focus on best practices for all staff — including medical professionals.

“We really have to understand the customer’s perspective if we are go to be able to deliver on our promise to provide the highest levels of care,” she said. “When people trust you, they see the best in you. We want every patient to see us at our very best.”

To that end, St. Peter’s physicians are reminded to sit at eye level with patients because “it’s important to create a trust, a bond,” Drumbore added. “Body language is important, as is creating a connection through conversation.”

At St. Peter’s, she said, every employee must meet the hospital’s service standards and understand the commitment they need to make. “We focus on providing clinical care as much as we focus on caring about our patients,” Drumbore said. “When you benchmark your success in those terms, everybody wins.”

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