The HCAHPS and Competency Connection

1. The HCAHPS and Competency Connection

2. OBJECTIVES: • Understand the HCAHPS initiative and VBP • Identify key components of HCAHPS that are linked to competency • Explore the impact of competencies on HCAHPS performance • Discover how to select appropriate competencies • Learn how to standardize competency selection process • Uncover ways to promote employee accountability

3. To improve the quality of healthcare by assessingand developing the people that deliver care. HealthStream’s VISION

4. Insights Online HCAHPS Impact Report Learning Platform Learning Measurement VBP Report Card Improved Performance Improvement Courseware Call Center

5. Understanding the HCAHPS Initiative and Value Based Purchasing

6. What is CAHPS? Consumer Assessment of Healthcare Providers and Systems • H-CAHPS: Hospital Inpatients • HH-CAHPS: Home Health Patients • CG-CAHPS: Physician Clinic & Group Office Patients • ICH-CAHPS: In-Center Hemodialysis Patients • LTC-CAHPS: Nursing home residents and family members • More to come!

7. Differences in Survey Question Scales Overall, how would you rate the care you received? Very Good Good Fair Poor Very Poor 53% 22% 14% 9% 2% During this hospital stay, how often did nurses explain things in a way you could understand? Always Usually Sometimes Never 40% 25% 25% 5%

8. The H-CAHPS Survey • Six Domains • Communication with nurses • Communication with doctors • Responsiveness of hospital staff • Pain management • Communication about medicines • Discharge information • Two Individual Questions • Cleanliness of hospital • Quietness of hospital • Two Overall Questions • Overall hospital rating (0 – 10 point scale) • Would recommend (4 point scale-definitely yes) HCAHPS USES FREQUENCY SCALE: Always Usually Sometimes Never

9. Data Adjustments CMS will take the data collected and adjust for… • MODE: type of methodology used (phone vs. mail vs. mixed) • PATIENT MIX: Service line, age, education, health status, language spoken in home, time since discharge, etc.

10. Public Reporting of H-CAHPS ResultsHow often did nurses communicate well with patients? www.hospitalcompare.hhs.gov

12. Patient Protection and Affordable Care Act VBP: Value Based Purchasing Program • Enacted March 23, 2010 • Repealed January 19, 2011 • A specified percentage (1-2%) of hospital payments will be conditional on performance • Critical Access Hospitals were not previously required to participate in HCAHPS

13. Value Based Purchasing (VBP) • CMS released VBP details January 7, 2011 • A percentage of a hospital’s base DRG rate is impacted • Reimbursement FY2013: 1.00% of payments • Reimbursement FY2014: 1.25% of payments • Reimbursement FY2015: 1.50% of payments • Reimbursement FY2016: 1.75% of payments • Reimbursement FY2017+: 2.00% of payments 70% of reimbursement based on 15 clinical and outcome measures 30% on HCAHPS survey results

14. MBQIPMedicare Beneficiary Quality Improvement Project Office of Rural Health Policy (ORHP): “This initiative takes a proactive approach to ensure CAH’s are well prepared to meet future quality requirements.” September 2012 – Phase II Began – included HCAHPS “Voluntary”

15. Identifying Key Components of HCAHPS Linked to Competency

16. The H-CAHPS Survey • Six Domains • Communication with nurses • Communication with doctors • Responsiveness of hospital staff • Pain management • Communication about medicines • Discharge information • Two Individual Questions • Cleanliness of hospital • Quietness of hospital • Two Overall Questions • Overall hospital rating (0 – 10 point scale) • Would recommend (4 point scale-definitely yes) HCAHPS USES FREQUENCY SCALE: Always Usually Sometimes Never

17. Hospitals Nationally Are Achieving High Scores

18. HCAHPS Overall Performance

19. Exploring the Impact of Competency on HCAHPS

20. Linking Employee and Physician Satisfaction and Competencyto HCAHPS Results Results of a Recent Multivariate Study: Employee and Physician Predictors of HCAHPS Scores: What factors/variables predict HCAHPS scores?

21. Methodology Sample: The sample included 237 HealthStream client hospitals. Data used were employee satisfaction scores, physician satisfaction scores and HCAHPS inpatient scores. Total Beds and Average Length of Stay were obtained from an external data source.

22. Methodology • A multiple regression analysis was conducted on the data. • Independent (predictor) Variables: • Employee Ratings of Administration • Employee Ratings of Immediate Supervisor • Employee Satisfaction/Loyalty • Physician Ratings of Administration • Physician Ratings of Hospital Efficiency • Physician Ratings of Nursing Skill • Total Beds • ALOS • Dependent Variable: • HCAHPS Overall Hospital Score

23. Summary of HCAHPS Predictors Three variables significantly predicted HCAHPS scores:

24. Implications • Employee satisfaction/loyalty and HCAHPS scores • Employee satisfaction is critical to inpatient care • Physician rating of nursing skill and HCAHPS scores • Importance of physicians’ perceptions of nursing skill • Employee ratings of administration and HCAHPS scores • This unexpected finding can help administrators understand potential low employee administration ratings in the quest toward HCAHPS improvement efforts

25. Selecting Appropriate Competencies: A New Era In Competency Assessment

26. What is Competency Assessment? Advances in patient care necessitate and compel nurses to continuously address evolving competency needs The skills and abilities nurses mastered and excelled in just a few years ago may no longer be as valuable or necessary today

27. The Evolution In the past, the focus has been clinical knowledge and mastery of technical skills. Today foundational competencies include: • Teamwork and interpersonal skills • Commitment to professionalism • Implementing evidence-based practice • Assessing communication abilities • Fostering safety improvements

28. Competency Defined Competency is the application of knowledge. It is measured at the bedside, in the job role. It is not assessed by: • Passing a test • Taking a course • Using a checklist

29. The Strategic Importance Patient Safety Quality Outcomes Employee satisfaction Patient Satisfaction Physician Satisfaction Verification of clinical expertise Reflective Practice Accountability

30. Competency Goals Drives standards of practice Standardization Accountability Establishes and determines your baseline

31. Quality Measures Interpretation of quality indicators serve as the baseline for competency assessment If quality indicators fall short or you have no evidence of any baseline data, this is the starting point

32. Empowered Assessments Don’t give out or choose the competency to be evaluated Establish a process to identify competencies selection Reinforce the process for competency selection Provide process to identify what competency needs to be assessed and they are not given the competency itself

33. Standardization Standardized the competency process rather than individual competency itself Competency will differ across units

34. Static vs. Dynamic • Competency is an ongoing dynamic process • Competency is ever changing • Don’t repeat the same competencies year after year • Your organization needs to focus it’s energy on the ongoing competency selection process • Initial Orientation competency drives safety • Annual competency drives organizational changes

35. Brainstorm First, Prioritize Second • What is new? • What is changing? • What is problematic? • What is high risk? • What is important to the employee? • What is time sensitive?

36. Data help drive process Collect quality data in a central location Review data to see if a gap can be identified No problem = no competency needed Gap identified? Show and discuss how you arrived at this conclusion and assign competency accordingly You may demonstrate something was considered, but a competency was not ultimately needed

38. What are the Competencies?

41. Medication Error A medication error occurred Situation investigated Asked an RN to demonstrate how he/she would calculate a pediatric drug dose RN did not routinely work with pediatric patients The RN could not do the calculation Corrective action…all RNs must take a medication exam annually True or False: Medication test proves competency?

42. The Truth • Medication tests prove very little • Nurses who are required to calculate medication doses for an unfamiliar patient population may: • Demonstrate ability to utilize internal resources to calculate medication dose • Use drug dose applications on mobile devices • Call pharmacy • Call pediatric units for staff support • Ask for another RN to double check calculation

43. Educators or Shared Governance They should not select all competencies They should reinforce the model to clarify infrastructure In the past, leaders select competencies and educators do the “doing” It’s a new era! Educator s demonstrate critical thinking Leaders should hold their team accountable

44. Education vs. Accountability How much money is spent on inappropriate education? Accountability issue or competency issue? When baseline or advanced competency level is achieved, but outcomes are not met, it is an accountability issue It is an educational issue, when skill is lacking It is an accountability issue, when will is lacking

45. Evidence of Achievement Place the employee in the center of the process Ask the employee to provide evidence of verification If employee refuses to provide verification, then an accountability issue is present

46. A New Approach Application of Knowledge Professional Practice Standards Evidence of Achievement Outcomes Not simply a check list any longer

48. Common Mistakes Don’t fall into the common competency traps Don’t repeat the same competencies year after year Don’t validate Don’t perpetuate Lets identify some common mistakes