The Centers for Medicare and Medicaid Services (CMS) and other payers regularly tout patient satisfaction as one aspect of future payfor-quality models. Standardized surveys that consistently and accurately capture patient satisfaction levels are growing in influence and importance.

CMS-produced patient satisfaction surveys have been used in hospitals for several years, so ASCs can look to hospitals as a meaningful example of how a CMS-implemented survey impacts future payments. Hospitals began voluntary participation in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in 2006. By July 2007, the Medicare Inpatient Prospective Payment System (IPPS) for hospitals was dependent upon completion of the survey and achieving satisfactory results. Medicare began reporting those results to the public in 2008.

For ASCs, the Outpatient Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) began its voluntary status in 2016, with a promise to begin public reporting in 2018. (Training has recently begun, and ASCs can learn more about the requirements and process at oascahps.org.) At this time, few ASCs are volunteering to participate. Some are hopeful that organizations, such as the Outpatient Ophthalmic Surgery Society (OOSS), will help CMS better understand ASCs and perhaps cut down the survey length, which is currently 24 questions plus additional demographic questions.

The survey is yet another regulatory requirement that may seem unduly burdensome, but ASC managers would do well to remember that the purpose behind the survey program is to ensure a positive patient experience. Says Glenn deBrueys, CEO of American SurgiSite Centers, “[The regulated survey programs] are a burden, but they also provide value.”

The ASC Customer

Patients don’t necessarily select the center where they have surgery; they typically follow their surgeon’s recommendation or go to an insurance-approved facility. Therefore, an argument could be made that the real customer being served is the surgeon or insurance company — so why not survey them instead? Although surgeons and insurers are important, the patient is the common denominator among the surgeons, insurance companies, and facilities.

Physicians want happy patients because the surgery center experience is an extension of their practice. Patients do select the surgeon, therefore, the surgeon cares about ASC satisfaction results. The insurance company wants happy patients because it wants more members, and patients who don’t have good experiences with the provider panels (physicians and facilities) generally don’t speak well of their insurance companies. The facility, meanwhile, wants happy patients because it wants its surgeons to be happy and continue using its facility. It makes sense that surveying patients — and responding to their comments — serves all three.

ASCs Know Surveying

CMS requires that Medicare-certified surgery centers conduct patient satisfaction surveys as part of their Quality Assurance and Performance Improvement (QAPI) program. In addition, ASCs that have undergone accreditation know the importance of capturing patient satisfaction and grievances and acting upon those findings. As a result, most centers have solid processes in place and understand the importance of these surveys.

Meanwhile, the OAS CAHPS system is a longer survey. Many centers may feel the process is out of their control, as surveys are conducted at random by a CMS-approved third-party vendor. However, ASCs that have been conducting surveys — and using the survey information to enact changes and improvements — should not be fearful of moving to this new system. To prepare for it, centers can review the OAS CAHPS survey questions to determine where there may be overlap with their existing survey. Some centers may simply reformat or revise their existing questionnaire to capture the newly required information. Kathy Wilson, vice president of quality for AMSURG, points out it is advantageous to begin using the reports (from the OAS CAHPS survey) now to start working on improvements if needed. This will help centers to be better prepared for meeting requirements when the program becomes mandatory and is tied to compensation.

Wilson says another advantage of starting the transition to the OAS CAHPS process early is working through the IT process. To comply with the reporting requirements that become effective in January of 2018, ASCs must contract with one of the CMS-approved survey vendors. Part of the process is uploading a file of patient data to the vendor, and it can take a few months to get established with a vendor and work on the file submission process.

An early start with the new process may give centers a general idea of how patients will respond and allow centers to proactively prepare for the CMS compliance and value-based payments.

Below are examples of best practices for conducting and using patient satisfaction surveys.

Capturing the Information

With any type of survey, the more information you can gather, the more meaningful and useful the data. Some centers find that paper surveys conducted while the patient is still on site provide the best return.

Nikki Hurley, director of surgical services at Texas-based Key-Whitman Eye Center, says that her on-site survey system yields “a 45% return rate, which is really good. If (patients) don’t have a chance to complete it on-site, we give them a postage-paid envelope to use.”

In agreeance, deBrueys says that paper surveys get higher capture rates but says they require more manual time. As such, the eight ophthalmic centers managed by American SurgiSite have moved to an online survey system. Online surveys make reporting easier for centers, because responses are captured, tabulated, and reported through an automated system. Hurley noted that the sophistication of the practice’s online survey is valuable and augments their paper process.

“The return rate varies between 10% and 30%,” deBrueys says, referring to the online survey.

Hurley and deBrueys agree that the best way to ensure patients complete the survey is to make the questions simple, direct, and relevant. They advise centers to:

1. Develop surveys by using sample tools that already exist from the accrediting bodies (e.g., AAAHC and Joint Commission); or now, the OAS CAHPS.
2. Keep it short and to the point.
3. Ask specific questions.
4. Review and update regularly to keep surveys relevant.

Implementing Change

The survey process is only valuable if centers take results-based action. Conducting surveys and reporting findings will feel exceptionally burdensome to center staff if the findings don’t result in changes or improvements.

“We report results to our QAPI committee and look for trends,” deBrueys says. “We also report back to the doctors.”

Because they’re collecting surveys on site, Hurley says they “go through the results daily and immediately address anything negative. If the patient gives a name, we call and thank them for their comment and let them know how we will fix it or provide an explanation of the regulation that may prevent us from changing.”

Both Hurley and deBrueys can provide multiple examples of how their surgery centers have improved because of patient comments.

“A few years ago, we were seeing an increase in complaints about wait times,” Hurley says. “We did a study and saw there was an uptick in more complex, mature cataract cases that were slowing our normal patient flow. We changed the way we were scheduling our cases, which helped reduce the wait times. And now we have automated wait time monitors that help us track every step in the process.”

According to deBrueys, American SurgiSite recently renovated one of its surgery centers based on patient complaints about space in the waiting area and the lack of privacy in the preoperative area.

Even seemingly small suggestions get consideration. Explains deBrueys, after patients voiced confusion regarding an exterior sign, it was fixed. Meanwhile, patient surveys helped Key-Whitman Eye Center learn that patients didn’t like their faces being “marked” for surgery, Hurley says. Thus, the practice changed its safety protocols to use VeriSite Adhesives rather than surgical marking pens.

Right Attitude

Centers that understand the importance of patient satisfaction and already have good systems in place should be well positioned to meet OAS CAHPS future requirements. Approaching the regulations with an eye toward positive change will make the work more worthwhile.

“If you take the attitude that it’s just a regulation, then you’re not going to be successful in developing a true performance improvement program,” Hurley says. “Doesn’t everyone want to improve and be the best for their patients? If you go about it with the right attitude, your patients will be the beneficiaries.” ¦

Maureen Waddle, MBA, is a principal and senior consultant at BSM Consulting.