Protecting, maintaining and
improving the health of all Minnesotans
Patient Experience Measures and Quality Compositing for
Total Care Hospital Reports
What is the issue?
In the total care reports released confidentially to hospitals in April 2013, hospitals were compared on
dimensions of cost and quality. The quality dimension included twenty-six process measures and sixteen
outcome measures. Patient experience measures from the Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) survey were reported, but not included in the composite quality score.
A number of stakeholders have argued that patient experience represents a critical component of
provider quality and should therefore be included in the quality composite of future PPG hospital
reports.
The Minnesota Department of Health is interested in discussions with the Advisory Committee about
whether patient experience should be included in future hospital quality composites and, if so, what
weight should be assigned to that dimension of quality vis-à-vis others currently making up the total
quality score.
Considerations:
In considering this issue, the Advisory Committee should weigh the following context:
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The HCAHP survey from which patient experience measures are drawn is a nationally
standardized survey of views of recently-discharged hospital patients on their hospital stay. The
survey asks patients to assess how well nurses and doctors communicated; whether patients’
pain was relieved; whether their room was clean and quiet at night; and whether information
about their ongoing care needs was shared with them. As such, the survey intentionally signals
the importance of information obtained directly from patients and reminds us that the patient
perspective is singularly informative for judging meaningful progress towards health reform
goals.
The initial PPG Advisory Group convened by MDH recommended that for the first hospital PPG
reports, patient experience measures should be reported outside of the quality score – that the
measures should be publicly reported, but should not become part of the overall quality score.
That recommendation was based on the relative recency of the development and public
reporting of these measures.
HCAHPS patient experience measures have now been publicly reported nationwide and in
Minnesota for six years. The CAHPS surveys are used in CMS pay-for-performance programs
(Hospital Value-Based Payment (HVBP), and Accountable Care Organizations) as a step towards
the goal of ensuring patient and family engagement in their care. In composites, the weight of
the patient experience measures ranges from 25 percent (Medicare Shared Savings Program) to
30 percent (HVBP).
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Protecting, maintaining and
improving the health of all Minnesotans
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At this point, patient experience reporting is not routinely required of all Critical Access
Hospitals. As such, requiring patient experience reporting as part of a stand-alone quality
dimension will eliminate some CAHs from reporting – hospitals that don’t meet the thresholds
for all quality domains are excluded from reporting.
Staff Recommendation
Staff recommends that patient experience measures from the HCAHPS be included in the quality
composite of the next PPG report and be initially weighted conservatively, at 20 percent. To
accommodate this addition, the weight of the other domains would be reduced proportionately, e.g.,
outcome sub-composite equal to 60 percent (was 70 percent), process sub-composite equal to 20
percent (was 30 percent), and patient experience sub-composite equal to 20 percent.
Finally, the Department should consider how to routinely obtain patient experience data from CAHs.
Until that is the case, patient experience should not be included as a stand-alone sub-domain in the CAH
hospital PPG report.
85 East Seventh Place • PO Box 64882• St. Paul, MN, 55164-0882 • (651) 201-3560
http://www.health.state.mn.us
An equal opportunity employer