Tips To Improve 5-Star Performance Ratings

Transcription

1 Tips To Improve 5-Star Performance Ratings Two different patient surveys impact CMS Star ratings: 1. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, typically mailed to plan members March June. 2. The Health Outcomes Survey (HOS), typically mailed to plan members April July. SCAN has compiled a list of questions from both surveys for which member satisfaction ratings declined in 2014 as compared to You can see exactly the questions your patients are answering. We ve also included recommendations to efficiently address these metrics. In general: People are more likely to engage in preventive health behaviors if they are told about the increased risk if they fail to do so, rather than the reduced risk if they do take action. Even if a patient doesn t seem ready or receptive to an idea, introduce it. Sometimes the mere hint of an idea or concept will trigger an association that can stimulate action. Acknowledge if there have been problems or issues and share how you have addressed them. Tell patients what they should expect and who to contact if those expectations aren t met.

2 5-STAR METRIC: CARE COORDINATION Q20 In the last 6 months, when you visited your personal doctor for a scheduled appointment, how often did he or she have your medical records or other information about your care? Q22 In the last 6 months, when your personal doctor ordered a blood test, x-ray or other test for you, how often did someone from your personal doctor s office follow up to give you those results? Q23 In the last 6 months, when your personal doctor ordered a blood test, x-ray or other test for you, how often did you get those results as soon as you needed them? Q25 In the last 6 months, how often did you and your personal doctor talk about all the prescription medicines you were taking? Q31 In the last 6 months, did you get the help you needed from your personal doctor s office to manage your care among these different providers and services? Q38 In the last 6 months, how often did your personal doctor seem informed and up-to-date about the care you got from specialists? q I do not have a personal doctor q I did not visit my personal doctor in the last six months q My personal doctor is a specialist You probably know all relevant information about your patient s medical history but does your patient know you know? Make sure they do it s a quick way to improve patient satisfaction with doctor-patient communication. Ask if the patient has seen any other providers and if you are aware specialty care has occurred, mention it and discuss as needed. Review patient medications on a regular basis to ensure you are up-to-date on any medications other providers may have prescribed, to verify safety, and to determine and encourage patient adherence. Tell your patients when they should expect test results ( by the end of next week ) and who will give them the results a staff member, your medical assistant, you? Do you let patients know when test results are normal? If not, be sure they know that but that they can call your office if they still want to check results. If your practice offers a patient portal, encourage online-savvy patients (or caregivers) to make use of it so they can stay on top of their care.

3 5-STAR METRIC: GETTING APPOINTMENTS AND CARE QUICKLY Q4 In the last 6 months, when you needed care right away, how often did you get care as soon as you thought you needed? Q6 Q8 In the last 6 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor s office or clinic as soon as you thought you needed? Wait time includes time spent in the waiting room and exam room. In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time? Recommendations for Your Staff: Ensure a few appointments each day are available to accommodate urgent visits. Maintain an effective triage system to ensure that frail and/or very sick patients are seen right away. Offer appointments with a nurse practitioner or physician s assistant to patients who want to be seen on short notice but cannot be seen by their doctor. Encourage patients to make their routine appointments for checkups or follow-up visits as soon as they can weeks or even months in advance. Be proactive and call patients months before their tests, screenings, or physicals are due and get them scheduled. Don t wait for the patient to call. Address the 15 minutes timeframe by ensuring the patient is receiving staff attention if provider is delayed measure vitals, engage in discussions related to HOS questions (urinary incontinence, fall risk, mental health, physical activity), etc. 5-STAR METRIC: GETTING NEEDED CARE Q35 In the last 6 months, how often was it easy to get appointments with specialists? q Never q Sometimes q Usually q Always q Someone else made my specialist appointments for me Q40 In the last 6 months, how often was it easy to get the care, tests or treatment you thought you needed through your health plan? q Never q Sometimes q Usually q Always Recommendations: Ask patients to call during mid-day and mid-afternoon hours later in the week when practices are typically not as busy. Suggest patients ask to be added to the wait list in the event of cancellations. If patients are unable to see the doctor they want, suggest they see a different provider in the same network.

4 5-STAR METRIC: IMPROVING BLADDER CONTROL Q42 Many people experience problems with urinary incontinence, the leakage of urine. In the past 6 months, have you accidentally leaked urine? Q43 During the past 6 months, how much did leaking of urine make you change your daily activities or interfere with your sleep? q A lot q Somewhat q Not at all Q44 Have you ever talked with a doctor, nurse, or other health care provider about leaking of urine? Q45 There are many ways to control or manage the leaking of urine, including bladder training exercises, medications and surgery. Have you ever talked with a doctor, nurse, or other health care provider about any of these approaches? Encourage nursing staff and medical assistants to ask patients about any incidents of urinary incontinence in the last 6 months. Patients are often too embarrassed to initiate the discussion. Educate patients about noninvasive behavioral interventions for UI; when necessary, refer for appropriate treatment. Make educational materials easily available so patients can use them as discussion starters for more sensitive topics. (Contact SCAN if you need resources.) 5-STAR METRIC: MONITORING PHYSICAL ACTIVITY Q46 In the past 12 months, did you talk with a doctor or other health provider about your level of exercise or physical activity? For example, a doctor or other health provider may ask if you exercise regularly or take part in physical exercise. q I had no visits in the past 12 months Q47 In the past 12 months, did a doctor or other health provider advise you to start, increase or maintain your level of exercise or physical activity? For example, in order to improve your health, your doctor or other health provider may advise you to start taking the stairs, increase walking from 10 to 20 minutes every day or to maintain your current exercise program. Recommendations: Have medical assistants assess patient s physical activity level. Review and address the assessment results as needed. Utilize appropriate educational materials and suggest community resources, such as gyms or fitness programs. Consider referral to physical therapy so patients with limited mobility can learn safe and effective exercises.

5 5-STAR METRIC: REDUCING RISK OF FALLING Q48 A fall is when your body goes to the ground without being pushed. In the past 12 months, did you talk with your doctor or other health provider about falling or problems with balance or walking? q I had no visits in the past 12 months Q50 In the past 12 months have you had a problem with balance or walking? Q51 Has your doctor or other health provider done anything to help prevent falls or treat problems with balance or walking? q I had no visits in the past 12 months Conduct a Medication Review with patients. Some medications or combinations of medications can have side effects like dizziness or drowsiness, increasing fall risk. Consider gradually withdrawing psychotropic medication and modifying other prescriptions, as appropriate, to reduce fall risk. Encourage annual eye exams and regular prescription updates for glasses/contact lenses. Consider referral to an occupational therapist for home safety evaluation and modification. Encourage exercise, specifically those that increase leg strength and balance. Make educational materials easily available so patients can use them as discussion starters for more sensitive topics. (Contact SCAN if you need resources.) These guidelines have been compiled from various organizations including the Centers for Disease Control and Prevention (CDC), The Mayo Clinic, Medscape Medical News, and The Cochrane Review.