Doctor's notes, stethoscope, and pen

According to leaders at Rush University Medical Center, CMS has been miscalculating hospitals’ star ratings since their release in 2016. As a recent Modern Healthcare article discussed, Rush’s leaders attribute the problem to flaws in CMS’s statistical model.

This incident highlights how external ratings systems leave healthcare organizations vulnerable. Rush’s researchers discovered how they don’t always measure up to the highest standards of validity. Further, they don’t reveal a complete picture of an organization’s care. Health systems can solve both problems by taking patient feedback into their own hands.

A limited view

The CMS’ star-rating formula is made up of hospital performance measures quantified in the following seven categories:

  • efficient use of medical imaging
  • timeliness of care
  • the effectiveness of care
  • patient experience
  • readmission
  • safety of care
  • mortality

Each of these categories has multiple factors that contribute to their score. The issue is that these aren’t weighted evenly. In the case of Rush’s star ratings drop, a measurement that contributed to the safety of care score, called PSI 90, had the biggest decline and therefore affected the most change in the numbers.

They used a model built on latent variable modeling which changes the weight of each component based on the variability. This inevitably leads to skewed data, as a computer calculates these changes and the weights assigned to them, which is often disproportionate. Showing a dip in PSI 90 meant that Rush had to perform above average in order to compensate for the dip that brought their star ratings down. Ultimately, this does not show a holistic view of the medical center’s performance.

A multifaceted picture of the care experience

While the quality and outcomes data represented in CMS star ratings provide valuable insight into the care experience an organization provides, it leaves much to be desired in expressing the patient’s perspective on their care.

A positive care experience from the patient’s perspective requires more than achieving the desired outcome, today’s healthcare consumer also expects ease. While healthcare consumers are generally satisfied with their care and outcomes (78 percent), over 80 percent would still switch providers for the sake of convenience alone.

Meeting heightened expectations requires achieving a greater understanding of customer preferences. Organizations cannot view care through an episodic lens, focused exclusively on outcomes. Instead, they need to design their services to develop an ongoing relationship between patient and provider.

The process begins by asking the right question at the right time to generate key themes and points of friction. Once identified, these can be further explored with in-depth qualitative feedback and analysis to surface high-impact opportunities for improvement.
When an organization starts asking the right questions, it’s easy to share a clear picture of their care experience with consumers.

A feedback-fueled reputation

Rather than relying on publicly reported or third-party measures to define the care experience, healthcare organizations have the opportunity to let their customers speak for them. After all, who has more, 100 percent verified consumer data about care experiences than the healthcare organization itself? Conducting this conversation with patients in real-time also keeps the feedback up-to-date and comprehensive.

The next step is publishing this feedback for consumers to see. Ninety-two percent of consumers consider ratings and reviews in their purchasing decisions, so it should come as no surprise star ratings and reviews are the most-desired feature on health system websites. Through these ratings, organizations have a tremendous opportunity to earn credibility with their customers.

But the benefits don’t stop there. In addition to accurately portraying care—via the most-preferred means—the practice of publishing customer feedback is recognized by search engines for its frequent, relevant and trusted content updates. The end result ultimately leads to higher search placement and increased web traffic compared to sites with fewer reviews.

Lessons learned

Sometimes, taking a step forward requires a step back. In this case, improving care for many healthcare organizations will require taking a step back to see the whole picture. Focusing too narrowly on any one measure of success takes the patient – the whole patient – out of focus. Taking a more holistic approach can help produce the most accurate picture of current care experiences, and help guide the way moving forward.

Steve Jackson
Steve Jackson serves as President of NRC Health. He joined NRC in September 2014, bringing nearly 20 years of experience advising health systems in a variety of terrains including, patient experience, physician engagement, and patient access. As President, Steve oversees company strategy and NRC’s portfolio of solutions that bring human understanding to healthcare. Today, NRC enables more than 75% of the Top 200 U.S. health systems to better understand the people they care for and design experiences that inspire loyalty. Prior to joining NRC, he held roles of increasing responsibility at Vocera Communications, The Advisory Board Company, Neoforma, and Stockamp & Associates. Steve graduated with honors from the University of California, Davis. Outside of the office, he serves as his family’s chief transportation officer, short order cook, and food and wine critic.

3 COMMENTS

  1. Only by listening to our patients we will improve their experience in our offices

    It goes beyond what they tell us while we´re talking with them, it´s about what they, and others, talk through social media,

    Digital channels are a reality and we need to listening what´s being talked over there

    Thanks for the post!

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