It is no surprise that providers recognize the significance of high patient satisfaction as patient-centric care models are on the rise. While more attention is given to tracking the patient experience, it is not only patient-centric care that is driving robust patient experience programs. High patient satisfaction ratings have become a central concern for providers across the country due to the tie to their potential bottom line. Patient satisfaction can have measurable consequences on hospital value based payments (HVBP). The HVBP program provides financial incentives to hospitals that provide higher levels of quality care to their patients.  There are both outpatient (OQR) and inpatient quality reporting (IQR) programs developed as a result of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.  These programs are aimed at providing consumers with quality of care information to make more informed decisions about health care options, and to encourage hospitals and clinicians to improve the quality of inpatient care provided to patients. The hospital quality of care data is summarized and available to consumers on the Hospital Compare website.

The HVBP is heavily reliant upon the results of the inpatient quality report (IQR) which includes quarterly patient satisfaction survey data collected through the hospital consumer assessment of healthcare providers and systems patient satisfaction survey (HCAHPS) conducted by the Centers of Medicare & Medicaid Services (CMS). Thus, the need to prioritize patient satisfaction in any given organization is paramount to optimal HVBP payments.

Although it is impossible to exactly predict how a patient will respond to a survey, a compliant patient experience program will provide valuable insights that aid in gauging the probability of  positive patient survey responses. A key component of a strong patient experience program includes response and resolution of patient complaints immediately when they happen, along with on-going collection of patient experience data related to complaints and grievances. This data can serve as a valuable assessment tool in predicting survey responses. Therefore, it is important to collect data related to complaints and grievances regularly. First published in 1986, the Conditions of Participation (42 CFR 482) contains the health and safety requirements that hospitals must meet to participate in the Medicare and Medicaid programs. These regulations include provisions for the investigation and resolution of complaints and grievances for participating providers, CoP (§482.13, A-0118–A-0123).

As providers are gearing up to enhance their patient experience programs, they should be mindful of the nuances associated with tracking patient experience data for complaints and grievances. When data are not accurate, performance improvement initiatives can suffer and lead to less than optimum HVBP reimbursement. In our next publication, AMS will provide more insight to what constitutes a complaint and grievance.