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Improving HHCAHPS Scores


On January 28, Medicare announced that home health agencies will be given stars based on their Home Health CAHPs scores.  You can see yours on Home Health compare.  When you find your agency on home health compare, there will be three tabs at the top.  On the third tab that reads, Patient Survey Results, you will see the responses that your patients gave in response to the HHCAHPS survey.

In order to have a response, at least 40 patients must be completed.  Data for agencies with 40 through 99 completed surveys is issued with a caution that reads:

Fewer than 100 patients completed the survey. Use the scores shown, if any, with caution as the number of surveys may be too low to accurately tell how an agency is doing.

In browsing the agencies in areas where I work, there is an alarming number of agencies that have no data submitted for the time period being reported.  The only exemptions from the HHCAHPS requirement are those agencies that have served less than 60 patients.  If your agency has a footnote stating no data was submitted for the reporting period, bring it to the administrator and Director’s attention immediately.  The Agency will be ineligible for future payment updates and may sustain a penalty.

Most agencies have information available.  Using a standardized questionnaire with neutral assistance from a paid vendor, patients are asked among other things, if:

  • They were told in advance of the services they would receive
  • Somebody from the agency asked to see all their medications’
  • Someone talked to them about all their medications
  • They were shown how to set up their home so they could move about
  • The agency seemed up to date about care and treatment
  • Their pain was assessed
  • The agency informed them about when they would be visiting

This is a partial list but should you want it all, you can find in multiple languages here.    Note that many questions are about how well the agency communicated with the patient.  Other questions from the survey assessed if the patients feel as though the agency respected them, addressed patient concerns, listened to the patient, communicated in way the patient could understand and if the agency treated them as gently as possible.

The survey concludes by asking the patient or representative if they would refer the agency to family or friends and how well, on a scale of 1 – 10 did the agency perform.

A few things to know.

Patients should not be prompted about the survey.  If the visiting staff does their job, there is no need to ‘prep’ the patient.  The agency should not use any of the questions in agency literature or marketing venues.  Example:  Choose Julianne’s Home Health where you will be treated with courtesy and respect and always know when your nurse will arrive.  Medicare thought it was important to tell you that you should not pay the patients to answer the survey.  Finally, should you choose to have a separate patient satisfaction survey, you should not use the same questions.  (Please don’t duplicate efforts!)

Luckily, once a contract with a Vendor has been signed, there is not a lot for the agency to do until reports are received.  Someone else does the survey, aggregates the results and puts them in a report for you.  Agencies are obligated to contract with a vendor and obviously, vendors must be paid.  You might as well use the data.  I am stunned by the number of nurses who are lost when talking about HHCAHPS.

My only Vendor experience is with Deyta and I never saw the need to investigate further. This is not to say that other vendors are not equally as qualified but I’m a consultant; not a personal shopper.  The fact that Deyta was so easy to work with and responsive to questions by email and phone gave me no reason to find other vendors.  They have recently been acquired by HealthcareFirst but it is not a requirement that HCF software is used to benefit from Deyta’s services.

In reviewing random and not so random star ratings, the responses across the board seem to be very high.  As such, any score under 92 percent should be taken seriously.  Include supervisory visits with RNs as well as LPNs to watch them communicate.  Do not assume that if a nurse comes across the wrong way to a patient that it is the nurse who needs to improve. The patient may have their own issues but when friction occurs, remove the nurse if you can.*  If you review your complaint log, you will likely find that poor communication is the root of most patient complaints.

Elderly people confined to the home may look forward to the nurse’s visit because they are alone more often than not.  Being late without calling upsets some patients more than bad lab results or a new diagnosis.  Really paying attention to the patient and hearing what they are saying is one way to show a patient how important they are.  Everyone deserves to be heard and if your visiting staff has one foot out the door to the next visit from the minute she arrives, the patient may feel as though they were not heard and become fearful that the nurse is missing something important they are trying to say.  Remember, the patient’s needs are not always documented on a plan of care.

Many of these results are improved by simple kindness, good southern manners and good care.  Shouldn’t those factors be the very minimum in your hiring requirements?  Even if you’re from up North?

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