Framework for CMS Patient Satisfaction Initiative

by Robert Nielsen
Gallup Healthcare Program Leader

In two September 2002 Tuesday Briefing articles (see Related Items), I outlined Gallup's preliminary position with regard to the proposed Centers for Medicare and Medicaid Services (CMS) national patient satisfaction standard. In these articles, Gallup challenged CMS on both its motivations and methodology.

On Nov. 18, the Agency for Healthcare Research and Quality (AHRQ) hosted a vendors' meeting to review the survey's purpose, development, and national implementation. An innovative and unique proposal was presented in that meeting, which Gallup and nearly every patient satisfaction measurement company present supported. The proposal suggested that one question be added to the beginning of each vendor's patient satisfaction survey. That question, with consistent wording and response patterns, would ask patients to rate their perceptions of the overall quality of their last hospital inpatient experience. Each vendor would report the results to CMS by product line (obstetrics, oncology, orthopedics, etc.).

This proposed process has a number of advantages, including the following:

  • Since almost all hospitals measure patient satisfaction on a continuous basis, the new standard would also be measured continuously, ensuring that thorough analysis can occur not only across facilities and regions, but over time as well.
  • The cost to hospitals would be minimal.
  • The survey question can be instantly piloted using both mail and telephone methodologies.
  • AHRQ and CMS need not incur the significant costs for research and development required to create a patient satisfaction survey from scratch.
  • Since it should be possible to compare across methodologies (i.e., telephone or mail surveys) vendors will not have to change their existing mode of patient satisfaction measurement.
  • Vendors will be able to continue their existing quality improvement programs with their current clients.

A number of Gallup clients have been approached regarding this proposal. Generally, they see it as an innovative way to achieve CMS's goal of providing consumers with customer perceptions of hospital care quality at minimal cost to the individual hospitals.

The primary objection raised in the meeting related to the problem of different vendors using different methodologies. In our view, this problem can be easily resolved once the pilot survey is completed, and the impact of differing methodologies on levels of non-response can be studied. Weighting systems, in conjunction with the minimum acceptable response/participation rates that CMS mandates, can be established to mitigate the effects of differing data collection methods.

AHRQ's original proposed pilot test using a mail-only methodology should be viewed with extreme skepticism. The cost difference is frequently cited as a reason for using mail surveys over telephone surveys -- but it tends to be a red herring. Single-wave mail surveys will fall short of achieving acceptable response rates. Well-planned, multi-wave surveys will be required, and properly conducted mail surveys are no less costly than telephone surveys. If the process is to be truly open to all vendors, mail and telephone methodologies must both be used in the pilot. The proposal outlined above covers both options. Most importantly, it eliminates much of the cost and red tape from the process and allows hospitals to continue their current patient satisfaction and quality improvement programs without interruption.

Key Points

At this point, the CMS approach remains in development and subject to modification. It would be premature for healthcare organizations to make significant decisions about their patient satisfaction measurement systems based on the current status, but the opportunity still exists for healthcare organizations to have input on the standardization process. Ideas, suggestions or concerns about the process should be communicated to hospital/professional associations or directly to CMS or AHRQ.

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