Illinois Hospital Association

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March 20, 2008

Upcoming Release of Hospital Compare - March 28, 2008; New: Patient Satisfaction and DRG Volumes and Payments

TO: Chief Executive Officers
  Chief Financial Officers
  Chief Medical Officers
  Chief Nursing Executives
  Quality Directors
  Public Relations Directors
  COMPdata Contacts


Hospitals should be prepared to respond to public and media inquiries regarding new information on their hospital’s performance to be posted on Hospital Compare starting March 28. The new information includes the HCAHPS Patient Experience/Satisfaction Survey and hospital comparisons on 43 Medicare DRGs by volume and average payment.

HCAHPS Background
While IHA has prepared background information and provided ongoing communications on this development (click here), there are some key items you may want to be aware of with respect to the upcoming release:

- The patient satisfaction topics include the results on 6 composite and 4 individual scores:
  • How often did doctors communicate well with patients (composite score)
  • How often did nurses communicate well with patients (composite score)
  • How often did patients receive help quickly from hospital staff (composite score)
  • How often was patients’ pain controlled (composite score)
  • How often were patient rooms and bathrooms kept clean (individual score)
  • How often was the area around the patient’s room kept quiet at night (individual score)
  • Were patients given information about what to do during their recovery upon discharge (composite score)
  • How do patients rate the hospital (individual score)
  • Would patients recommend the hospital to friends and family (individual score)

    • - The Centers for Medicare and Medicaid Services (CMS) has opted to display hospital comparative results showing only responses for "always" when the viewer first accesses the site. Consumers can drill down to results for "never" and "sometimes," but those responses will not be on the initial web site page.

    - Hospital scores from their vendors will not match the individual scores from CMS due to CMS applying adjustments based upon the type of survey mode method utilized (mail versus phone or combination) and patient mix (i.e. patient age, education, etc.). While the methodology and co-efficients for the survey mode method has been fully disclosed by CMS, the methodology and co-efficients for the patient mix adjustment have not been disclosed.

    Suggestions for Talking Points
    In addition to talking points provided by AHA, hospitals should also consider the following as well:

  • Designate a contact person who understands the HCAHPS survey results and can address any questions. Make sure that they understand or have readily available staff who can respond to questions on the HQA process and mortality measurements as well as variation in DRG volumes and payments.
  • Make sure that your hospital has identified opportunities for improvement and can describe any action steps underway. As the focus will be on ‘always’ responses, make sure there has been internal hospital discussion on these results.
  • Since using a non-mail mode for survey administration may reduce your performance scores, be ready to explain the background for utilizing phone or combination approaches to survey administration.
  • As results will vary with information provided by your vendor due to CMS application of survey mode and patient mix adjustments, make sure your board members, executive team, and others you have shared your information with understands the reasons for variation.
  • If your hospital did not participate in the HCAHPS due to timing or small cell size response issues, be prepared to share patient satisfaction results that you have with the media. Explain why your hospital did not participate and what your future plans are for sharing this type of information with the public.
  • Consider sharing your own individual hospital results with media prior to the public release of the information. This may allow you to shape the message and explain your areas of strength and opportunities for improvement.
    •

    Medicare DRG Volume and Average Payment Background
    CMS will be releasing hospital comparative information on 43 select DRGs by hospital Medicare volume and average Medicare payment. The information will cover federal fiscal year 2006 which spans Oct. 1, 2005 through Sept. 30, 2006 inpatient discharges. Please keep in mind that this will not apply to non-PPS hospitals.

    In reviewing similar past releases of this type of information on the CMS web site (see http://www.cms.hhs.gov/healthcareconinit/02_hospital.asp and then click on 2006), there is a wide variation among providers and between CMS overall average payments and average charges. Remember that the federal fiscal year 2006 DRG payment system has now been replaced by the Medicare Severity DRG (MS-DRG) payment system starting Oct. 1, 2007 that takes into account patient complications and comorbidities.

    Suggestions for Talking Points
  • Designate a contact person who can clearly explain the variations in payments in layman’s terms for the public and any media that raise questions. Have additional contact people available should there be questions on HCAHPS or the Hospital Quality Alliance process and mortality outcome measurements.
  • Explain the patient mix of your hospital to account for greater volumes and also other service offerings more common to non-Medicare patients.
  • As DRG payments are based upon a blended formula approved by Congress that takes into consideration operating and capital amounts, it is not a reimbursement set by the hospital. Rather Medicare establishes the operating amount based upon the wage index, wage adjusted labor-related amount, non-labor related amount, DRG weight, indirect medical education, and disproportionate share add-on amounts. The capital amount takes into consideration the geographic adjustment factor, DRG weight, indirect medical education, and the disproportionate share add-on amounts. Also, remember there are additional payments for outlier cases within a DRG.
  • If your hospital does not have information displayed, you may want to be prepared to respond to any inquiries on reimbursement methodologies utilized by Congress for CAH providers.
  • If your hospital provides a service now or did so at that time, but had limited volume due to the reporting on Medicare patients only, you may want to be prepared to provide commentary on the information.
    •

    As one never knows how this information will be perceived or utilized by the public and news media, it is best to review your hospital information and be prepared to respond to inquiries. The release will occur on a Friday afternoon, March 28, so it is difficult to gauge whether the news media will use this for weekend news or during the following work week. IHA will keep you updated on any changes or additional information regarding the upcoming release. If you have additional questions, please contact Pat Merryweather at pmerryweather@ihastaff.org or Danny Chun at dchun@ihastaff.org. Thank you.