More about ACOs: patient satisfaction

Accountable Care Organizations (ACOs) are a newly-defined health care delivery structure that is intended to radically overhaul healthcare, and result in a coordinated way of delivering care based on quality outcomes, rather than simply fee-for-service volume.

ACOs are defined in the 2010 Affordable Care Act, and are initially intended simply for traditional (fee-for-service) Medicare. However, given how the Centers for Medicare and Medicaid Services (CMS) influence the entire health care delivery system, it would not be surprising if commercial health plans also seek out successful ACOs as a delivery platform for their enrollees as well.

Last week, the U.S. Department of Health and Human Services (HHS) released their proposed rule for defining ACOs, with a 429-page document that is now open for a 60-day public comment period. HHS and CMS will then digest the comments and issue a final ruling later in the year. The ACO program (as HHS defines it) will begin January 1, 2012.

As proposed, ACOs are challenged to meet fairly high standards if they wish to participate in the upside benefits of cost savings resulting from improved care coordination. There are actually 63 specific measures being proposed, which fall into 5 domains:

  1. patient/caregiver care experiences
  2. care coordination
  3. patient safety
  4. preventive health
  5. at-risk population/frail elderly health

We will look a little deeper into each of these domains in a series of EHR Blogger posts. In this post, we will take a closer look at the domain of Patient/caregiver care experiences.

Patient experience
The Patient/caregiver Experience domain contains 7 criteria, which basically mirror patient satisfaction surveying that has been occurring ad-hoc for a number of years. The measures that ACOs need to report on, in this domain, are:

  1. getting timely care, appointments, and information
  2. how well your doctors communicate
  3. helpful, courteous, respectful office staff
  4. patient’s rating of doctor
  5. health promotion and education
  6. shared decision making
  7. health status/functional status

The first 6 of these measures reference a National Quality Foundation (NQF) measure #5, and the 7th measure reference an NQF measure #6. The NQF measures, in turn, reference survey tools that have already been offered (free to the public) by the HHS Agency for Healthcare Research and Quality (AHRQ). Specifically, the AHRQ has collected a full set of Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and reporting kits, and contain a Clinician and Group Survey and Reporting Kit (what the NQF #5 measure references, and is therefore what is included in the first 6 ACO measures), as well as a Health Plan Survey and Reporting Kit (what the NQF #6 measure references, and is therefore what is needed for the 7th ACO measure).

What this means is that an ACO doesn’t need to re-invent the wheel when it comes to doing annual surveys of patients about their care experiences. HHS already has those resources, freely available. In fact, the proposed rule for ACOs is quite proscriptive, and specifically requires these tools be the standard ones that ACOs use to assess patient experience.

The larger picture
Assessing patient experience and patient satisfaction has been around for a long time. It has informally been used by practices, here and there, to improve their “customer service” abilities. In arenas where Pay-For-Performance has been in place (such as risk-taking IPAs and Medical Groups in California, for their HMO-contracted patients), Patient Satisfaction has been a measure domain for many years. The survey tools have generally been sent out annually by health plans, or by surrogates for the health plans.

By making the measurement of patient experience a requirement for ACOs, we are seeing the emergence of national policy that includes this kind of “customer satisfaction” as part of performance-based pay. This is an important point in the evolution of health care delivery.

In subsequent EHR Bloggers posts, we will look a little deeper at the other domains of measurement for ACOs. The implications this has on overall health care delivery in the U.S. (despite the fact that ACOs are currently just for Medicare fee-for-service patients) is ground-shaking.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR