Posted May 19, 2016

The Patient Experience: Does this Really Matter?

By Dan Smith, M.D., FACEP

Patient perception. CG CAHPS/HCAHPS. Voice of the consumer. Patient-centeredness. Communication skills.

This short list includes just a few of the terms and tactics around patient experience. These previously uncommon phrases are now forefront in our healthcare playbook of goals and strategies. Let's explore the questions below:

Are the efforts to drive patient experience grounded in medical science?

A growing collection of peer-reviewed literature exists that supports the notion of patient perception of care as a marker of care quality. The CRUSADE trial studied over 6,000 acute myocardial infarction (AMI) patients and examined the mortality of this cohort as a function of their perception of care scores (Glickman et al, Circulation 2010). They also measured guideline adherence. In risk-adjusted cohort comparisons, patients with higher patient experience metrics showed lower mortality from AMI. Interestingly, their adherence to treatment guidelines was higher.

Studies looking at factors influencing hospital readmissions suggest that patient perception of care is an important predictor of readmission (Boulding et al, American Journal of Managed Care 2011). Lastly, a large systematic review of patient experience literature led by Doyle et al in BMJ Open found linkage of patient experience to favorable quality outcomes and reduction of complications of care in >77 percent of international studies (22 percent of studies found a neutral association).

The mounting data supports the notion that patient perception of care and our ability to communicate and connect with patients is an important driver of patient quality outcomes, adherence to medication and treatment regimens, and avoidance of readmissions and complications.

Will patient experience efforts help us thrive in the complex and changing world of healthcare?

Healthcare models of care have evolved and how we enumerate performance has changed:

Past Future
volume volume + value
health maintenance organization (HMO) Accountable Care Organization (ACO) / physician-hospital organization (PHO) /Clinical Integrated Network (CIN)
paternalistic mutualistic
usually always
effort performance
care care + perception of care

We now practice in a world of ever-increasing transparency and accountability where process of care, outcome of care and perception of care are scrutinized. Those who embrace the change, align and outperform on these evidence-based measures will not only receive full payment for services but also value-based bonuses. The recent replacement of Medicare's sustainable growth rate with the MACRA program that will be implemented over the coming years further emphasizes transparency and accountability to patients. As envisioned, MACRA has a heavy emphasis on rewarding those physicians and medical groups that receive high patient experience scores and other quality (value) measures. Those that are unable to focus on these core competencies will see significant reimbursement reductions. In a new reality of reduced operating margins from risk-withholds and complication/readmission penalties, enterprises that coach and train staff and providers to thrive in the new age will appreciate loyalty and growth, risk reduction, favorable bond ratings and market differentiation.

How can a provider accept and embrace the change?

Think about this through the lens of our customer, the patient. We are driven to understand the complexities of science and medicine and apply technical and cognitive mastery to the healing arts. Patients may not understand clinical explanation at our level but they sense kindness and empathy, which can often act as proxies to care quality and ratings of care.

Don't traverse the change alone. If you feel you received little to no training on communication skills and don't know where to begin, reach out to subject matter experts who know the evidence-based skillsets that will elevate your game in communication and connection to patients.

Embrace it, accept it and get it done. Keep it in perspective though. Truth is, you still assess and treat the patient. You still order appropriate testing and treatment. You will formulate a differential and ultimate diagnosis. Do we have to think differently about the way we communicate and behave? Yes, we do, and this is not a soft skill: the physician domain remains one of the most difficult "top box" composites in CG CAHPS and HCAHPS to elevate and sustain. Pay attention to the skill sets that beget performance on patient experience, deploy a couple tactics to improve communication (AIDET® is one) and be consistent in their use. With some practice and time, this will become the new way you communicate. Soon after, you will receive positive feedback from patients and families and you can even save time in patient interactions.

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