MINUTES: HEALTH CARE HOMES PEDIATRIC PATIENT EXPERIENCE MEETING
DATE: Tuesday, July 17, 2012
Participants
Name/Organization
Collette Pitzen, MNCM
Marie Maes-Voreis, MN Department of Health
Terry Murray, Allina
Elsa Keeler, HealthPartners
Erik Bjerke, Children's Hospital and Clinics of MN (Mpls & St. Paul)
Rachel Vocal, Owatonna Clinic
Mary Hauck, MN Department of Health
Wendy Berghorst, Park Nicollet
Sharon Quinlan, Essentia Health_Duluth Clinic
Laurie Dahl, Dan Hart, Emily Goetzke, Liz Thompson, Marcia Bahr, Mankato Clinic
Connie Blackwell, North Metro Pediatrics
Leanne Roggeman, Fairview Health Services
Agenda Item
Welcome and Introductions
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•
Notes
Welcome workgroup members and introduce participants
Background on HCH patient experience requirement: Marie Maes-Voreis, from the
Department of Health, reminded the workgroup that when the HCH rule was written back in
2009 two of the main goals were to include all patient populations and address health care
quality with a focus on the triple aim (cost, quality, patient experience). The HCH rule is
different from the Statewide Quality Reporting and Measurement System (SQRMS) rule
Time
15-minutes
Agenda Item
Notes
because SQRMS only requires adult patient experience reporting and does not require
pediatric clinics to report patient experience data. Additionally, the HCH rule has a
requirement that patient experienced surveying be done annually, whereas, the SQRMS rule
requires a survey be done every two years. MDH asked MNCM to convene the HCH pediatric
clinics for this meeting to a) explore what HCH pediatric clinics are currently doing in regards
to patient experience surveying, b) recommend a plan for reporting patient experience data
in 2013 to MDH, and c) discuss the pros and cons of having clinics switch to the PatientCentered Medical Home survey.
QUESTION: Would the Department consider changing the HCH patient experience requirement to
every other year to align with the Quality Rule?
MDH Response: At this point probably not because it would require MDH to change the
HCH rule which can be a difficult and cumbersome process. However, the Department does have
some flexibility around what is required for patient experience. For example, one option might to
have clinics choose to do a quality improvement process around patient experience during the off
year, as opposed to conducting a surveying every year.
Response: SQRMS choose not to do annual patient experience surveying because of cost
and the additional burden it put on clinics. If MDH requires annual HCH patient experience
surveying then clinics will face these same two challenges and could have the negative effect having
clinics choosing not to become certified. Additionally, studies have shown that it takes two years for
patient experience data to reflect any significant changes because of the time it takes to implement
improvements
MDH Response: The Department understands these concerns and is going to look into
investigate the sensitivity of the PCMH tool to see if there are significant enough changes over the
course of a year to make annual surveying worthwhile. If the Department chooses not to collect
patient experience data every year, then they would still need to require something around patient
experience because HCH certification is annual and patient experience is part of the requirements
for HCH recertification.
•
Update on the PCMH CAHPS comparability study: MDH contracted with NRC picker to test
the equivalency of the CG-CAHPS survey to the PCMH-CAHPS survey. The purpose of the study
was to test whether or not both survey produce the same results for purposes of public
reporting. All of the core questions are the same; however, the PCMH survey has additional
questions pertaining to patient-centeredness and care coordination. Five health care home
clinics participated in the study where both surveys were distributed in a 2-month time frame.
The results are expected sometime this fall. If the two surveys are equivalent then the
Department will allow HCH clinics to distribute the PCMH adult version of the CAHPS survey in
place of the standard CG-CAHPS survey.
Time
Agenda Item
HCH Pediatric Patient
Experience
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•
•
Notes
Exploration: what are clinics currently doing in regards to pediatric patient experience surveying
o Types of tools currently in use, frequency of survey activity (see Excel spreadsheet)
o What did the Department do in 2011 to have clinics meet the HCH patient experience
requirement? For clinics going through recertification in 2011 the Department had
clinics provide information about what quality improvement initiatives were initiated
based on the results of their previous patient experience surveys. The focus was on
getting clinics to use their patient experience data to drive improvements in quality. In
the future, the Department expects to use the results of the patient experience data
alongside a clinic’s quality and cost measures. However, for the first year of
recertification the expectation was for clinics to begin using the data to develop quality
improvement initiatives. In the future, the Department will use the results of CGCAHPS survey for adult clinics to determine benchmarks for patient experience.
However, since pediatrics is not included in the SQRMS CG-CAHPS requirement MDH is
still determining what will be required for HCH pediatric clinics. The ultimate goal is to
have HCH clinics using the adult or pediatric PCMH CG-CAHPS tools which would allow
for benchmarking and standardization among all HCH clinics in the MN and nationally.
If the PCMH survey turns out to be equivalent to the CG-CAHPS survey then the PCMH
tool could serve as a replacement of the CG-CAHPS. This would cut down on the
redundant surveying.
Education and reporting : reporting current pediatric patient experience data to MDH
o MDH asked for input from the group in regards to reporting key questions to MDH for
recertification in 2013. Workgroup members generally agreed that “Willingness to
recommend” and “How would you rate your doctor” are questions that are common
every type of patient experience survey so if the Department decided to collect data
from the various surveys conducting by each clinic then the likely overlap would be
those two questions.
o One challenge identified by the group is trying to align all their survey mandates (ACO,
state of MN, and other contracts. The cost of fielding this many different surveys is
enormous plus some surveys require certain populations vs. the entire clinic
population. The specific populations have to then be excluded from the other surveys
so they don’t get surveyed twice in a cycle. Breaking up the population also makes it
more challenging to reach statistical significance. For example, the ACO patient
experience survey mandate requires all patient experience surveys from Medicare
patients.
Planning: implications of future HCH Pediatric Patient Experience Survey requirements
o Cost of switching to PCMH-CAHPS Pediatric Patient Experience survey: Philosophically
Time
1hr 25 minutes
Agenda Item
o
o
Notes
if the surveys are equivalent then the PCMH survey is preferred because care
coordination and patient-centeredness should be a universal goal of all primary care
clinics regardless if they are HCH clinics or not. Clinics were unsure how much their
survey vendors would charge if they decided to switch to the PCMH survey. MDH did
ask Dale Schaller to put together some recommendations related to switching over to
the PMCH survey. These recommendations will be available this fall when the results
of the survey equivalency and published. Additionally, Cherylee Sherry from the
Department of Health has put together a grid to assist clinics with the transition and
timing for switching to the PCMH survey. MDH offered to share this grid with clinics
once a decision is made after the equivalency test is complete.
Timeline for switching to PCMH-CAHPS Pediatric Patient Experience survey: The
Department is cognizant of the challenges associated with switching to the pediatric
PCMH survey and welcomes input from clinics and MNCM about the appropriate
amount of time it takes to switch survey instruments. The earliest the Department
would require the PCMH survey is sometime in 2013, however, no formal timelines
have been established.
What is MDH’s plan for collecting patient experience data during the off years of the
SQRMS patient experience requirement? This is still under discussion and
consideration at the Department. MDH welcomes ideas from clinics on what the off
year requirement should look like. One idea offered from the group is to have clinics
offer a survey to just those patients who are receiving additional care coordination
services as opposed to surveying the entire population. It seems that some of the
clinics have already developed their own surveys which are specifically designed for the
care coordination patients. So requiring surveying of just care coordination patients
during the off year should not add too much additional burden on HCH clinics.
Another idea proposed by the group is to use patient experience data that has already
been collected and instead of rolling the data up for meeting reporting requirements,
rather have clinics break down the data by clinic or individual provider and then choose
a quality improvement strategy based on the areas of improvement identified in the
survey. Another idea is to figure out a way to get direct feedback from children and
teens and truly listen to what patients are saying. One workgroup member suggested
that many clinics already do have specific quality improvement initiatives in place
pertaining to the patient experience data they are collecting, thus one idea for the off
year is to have clinics submit the data they are collecting along with their quality
plan/strategy. It wouldn’t allow for external benchmarking, however, MDH could start
tracking the clinics internal improvements and perhaps develop some separate
benchmarks for clinics depending on their quality improvement area of focus. This is
Time
Agenda Item
Future Activity
Notes
similar to what MDH did in the past, however, MDH suggested that we could structure
this information better into a 5-6 question survey that could be given to all HCH
clinics. If a common clinical survey was used then MDH would be closer to their goal
of having standardized information to help develop benchmarks for recertification.
Most clinics have to file with ICSI their QI strategies and data, so these reports may
already exist. The workgroup emphasized strongly that they want HCH clinics to
maintain the flexibility of developing their own QI initiatives rather than having
something dictated for them. The current HCH requirements allow for this flexibility
and the workgroup felt this was strength of the program and shouldn’t be changed for
the purpose of trying to standardize data collection. MDH acknowledged this as
strength of the program and confirmed their commitment to allowing clinic’s the
flexibility of developing their own QI initiatives,
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•
•
•
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MDH will work with pediatric clinics to determine which key questions will be reported to MDH
in 2013
MDH will establish a timeline for reporting 2013 patient experience key questions
MDH decision on whether or not to proceed with the PCMH-CAHPS Pediatric Patient Experience
survey
Is 12-months from now an adequate enough time to switch and implement the PCMH tool for
pediatrics and/or adults? The more time the better. It will be tricky depending on timing and
budgets. Many budgets
If MDH decides to have pediatric clinics align with the Quality Rule’s patient experience
requirement then the first time data collection for the pediatric PCMH CG-CAHPS tool would
occur is the fall of 2014. This would give clinics a year and a half to prepare for the PCMH
survey. The workgroup felt this was a reasonable amount of time and reiterated that ‘the
sooner a decision is made the better’ in order to prepare for the transition to the PCMH survey.
What can a small clinic do minimize the cost of transitioning to the PCMH survey? Utilizing the
central survey vendor is a way to reduce the cost of the administering the survey. Additionally,
in 2014 MDH will investigate the possibility of the having the central survey vendor offer both
the PCMH and CAHPS surveys so that a small clinic has the option of using the central vendor
and thereby taking advantage of the guaranteed price offered by the vendor. The CG-CAHPS
website is very helpful and all of the resources are downloadable. LINK TO CG-CAHPS:
http://cahps.ahrq.gov/clinician_group/
1.
Ask quality rule about decision making for sampling methodology (e.g. phone sampling vs.
email)
Time
20 minutes
Agenda Item
2.
3.
4.
5.
6.
7.
Open Questions
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Notes
Info from Dale Shaller on sample size for pediatrics? The same or different from adults?
Get in writing from Dale the recommendation that clinics use different patient experience
tools for pediatrics vs. adults
Understand better the cost shift from CG-CAHPS to the PCMH survey, MDH has asked Dale
to put together some recommendations around this.
Dillema of 13-17 year olds? Do adolescence get their own survey
Ideas on what to do for the off year? (look at setting a standardized report back form so
that MDH collects the same information from everybody) MDH could allow clinics the
choice to submit patient experience data on the off year if possible. Also, look into what is
being reported to ICSI because that is already standardized.
What do to around benchmarking for patient experience?
If a clinic has a mix of pediatric and adult patients what is the appropriate sample size if you
want to survey both populations? Should the sample be split between pediatrics and adults?
Conducting separate pediatric surveys doubles the cost because essentially one clinic has to pay
for two different surveys to be implemented. Also, it becomes more difficult to a statistically
significant number of pediatric survey responses if a clinic only has 1 or 2 pediatricians. With
the CG-CAHPS survey it is always recommended to have two different surveys for adults and
pediatrics as opposed to using one general survey for your entire population. Adding the
pediatric survey to a family medicine clinic essentially doubles the cost because a clinic has to
send out twice as many surveys in order to reach statistical significance for both adults and
pediatrics.
13-17 year olds require additional confidentiality issues so some clinics do not survey these
patient populations because there are significant challenges in regards to ensuring patient
privacy. It is also hard for some medical groups to identify exactly which visits are considered
“confidential visits.” Workgroup members acknowledged this as a significant concern because
13-17 year olds can receive additional care coordination services and benefit from the HCH,
however, without capturing their patient experience data it is very difficult to know if a pediatric
clinic’s survey results are accurate.
Email vs. Mail survey: how do you handle those patients who don’t provide an email? If a
patient doesn’t have an email they are not included in the original survey pool. However, for
those without an email address a mailed survey will go out.
Time