Research paper

Running head: INTRAVALLEY HEALTH 1
Intravalley Health: Patient Experience and Satisfaction Surveys
Modupe Sarratt
University of Maryland University College
HCAD 660-9041
Research Paper
March 25, 2018

INTRAVALLEY HEALTH 2
Abstract
In today's healthcare, the patient expects a certain level of care when walking into a healthcare
facility and presumes a certain level of care and experience based on each and every interaction
patients have within that facility. In order to measure patient experience and satisfaction,
Intravalley Health must understand the dynamic of healthcare regulations of medical care
services for patient care. Patient experience refers to the multidimensional set of factors that
include healthcare service, medical care service, emergency and hospital services, patient care
and nursing care, urgent care, rehabilitative care and hospice care services. The complexities of
this dynamic are governed by many healthcare laws and regulations. To ensure compliance,
Intravalley Health must adhere to Health Insurance Portability and Accountability Act of 1996
(HIPAA) for procedures and quality of care and the Affordable Care Acts (ACA) of 2010 for
policies and provisions. These legal guidelines are in place to determine whether a patient has
coverage, and they also set the administrative rules which apply to the Center for
Medicaid/Medicare Service (CMS) for deciding whether to treat a patient. To indicate that
patient experience encompassing the dimension of provider performance for policy and
procedure are difficult to measure for patient satisfaction. A journal article by Carrus, Cordina,
Gretz, & Neher (2015) implies that “patient satisfaction is likely to become an increasingly
important source of competitive advantage. Yet many providers cannot measure the patient
experience comprehensively” to show that there is more to learn about the patient experience.

Intravalley Health: Patient Experience and Satisfaction Surveys
Intravalley Health is a healthcare organization that strives to provide quality care for their
patients; they value their patient’s feedback to make improvements to their health services. The
organization strives to be customer-friendly, as their main concern is to provide the correct and
wanted services to their patients. Surveying and internal analysis of the patient experience at
Intravalley Health revealed that patient satisfaction is linked to medical procedures and
healthcare services. In order to improve the patient's experience, the staff at Intravalley Health
must understand the patient's experience for the cause of medical care and the patient’s
satisfaction for the effect of health care services.
Patient experience for the cause of medical care
There is no specific concept to define the patient experience as a measurement of quality
care for medical procedures performed by the medical providers. Due to the dynamic of
healthcare services for medical procedures, internal medicine is regulated by insurance policies,
which reimburse for provider performance. Provider performance is “the normative and
formative for the payment systems of quality care” (Berkowitz, 2016). According to the
departments and centers for general internal medicine (GIM), the physicians who are board
certified specialized in the care of adult patients with various symptoms and medical issues with
undefined symptoms for the procedure performed by the providers. Mayo Clinic. org (2018), the
staff describes GIM procedures as follows:
Patients are seen in general for health examination as well as for consultation. The
procedure depends on the complexity of patient medical problems. Providers provide
preventive screening services for health maintenance, such as mammograms, Pap smears,
routine colon cancer screening, cholesterol screening, and blood pressure screening. For a

patient with medical problem, providers provide comprehensive management of medical
needs.
The GIM procedures are the type of health services rendered by Intravalley Health providers that
may include other services that cater to the needs of the elderly. For example, elderly patients are
more subjected to depressive symptoms for the complaint of chronic pain, depression is a
predisposition for indigestion, constipation, and diarrhea. As well, a depression can be the cause
of a chronic headache and stomachache, sleeplessness, and fatigue. 75% of Intravalley patients
are 50 years old plus, while the remaining 25% are between 30 to 50 years old and generally
only seen for routine checkups.
One of the problems observed affecting elderly patients is the lack of assistance with
daily activities. For that reason, Intravalley Health needs to extend care beyond written office
policy in order to bolster the patient’s experience of quality care. However, patient complaints
stem from limited access to care designed for post follow-up with doctors. Patients often never
follow-up, as they do not feel the need if no medical service is imperative and they feel fine. Per
policy, follow-up appointments are required within a 2-week period in order to refill any
medication; otherwise, another diagnosis must be performed. Patients are largely unaware of this
policy, feeling as though they are denied care for simply not abiding with provider
recommendations.
Patient Patricia Mellow allowed her experience to be used in order to help improve
Intravalley Health’s services. Mrs. Mellow, 68 years old, along with her husband, 82 years old,
took it upon herself to assist her husband in getting the care he needed, as his primary caretaker.
Due to differing schedules and conflicts, Mrs. Mellow could not accommodate the follow-up
date for both herself and her husband. The issue therein lies with follow-up appointments being

too regimented and not flexible enough to accommodate patients, discouraging them from
complying with procedural policies. Mrs. Mellow was not comprehensively briefed on the
enacted policy that follow-up procedures are required after each initial treatment. Overall Mrs.
Mellow had a negative experience in which she was denied care due to misconstrued policy.
These are the types of scenarios that many patients can relate to for patient experience,
however, these are not the type of experience that can be measured by a survey for provider
performance; because patients internalize bad service for the poor quality care of medical
practices for dissatisfaction with health services. Patient expectations are not reflected in their
complaints and they feel that procedures and policies are inconsistent with the care that they are
receiving. Patient experience measured by using a survey developed by the Centers for Medicare
and Medicaid Services (CMS) to gauge clinical care setting is “inpatient service that patients
perceive for their hospital stay” (Carrus et al, 2015) to suggest that hospital patient surveys are
not for quality assurance of the provider performance for procedure, therefore, the hospital
patient survey cannot be used to measure a patient experience for patient satisfaction in a clinical
setting for a procedure (Appendix I, Patient Satisfaction Survey).
The cause of negative patient experience is from the strict regulations, policies, and
procedures of healthcare services in compliance with the Affordable Care Act (ACA) and all
HIPAA regulations. The Affordable Care Act's provision of healthcare service is through "a
series of requirements that sets forth health plans related to (1) designation of a primary care
provider, (2) coverage of emergency services, and (3) elimination of referral requirements for
obstetrical or gynecological care."(Office of Legislative, 2016) included in the medical
procedure for clinical evaluation with test and prescription to assure quality reporting of a

treatment and management of chronic diseases, and others services for evidence-based to
measure physician performance for quality of payment system to reimburse for health services.
Although the provision of care to Medicaid-eligible adults issued in 2010 include the
category for "Family Experience, this inclusion is not about the patient experience of quality
care" (Federal Register, 2010). Referring back to Mrs. Mellow's experience, she was unhappy
with having to retake a physical examination for a prescription refill, due to missing a follow-up
when she felt there was no cause for concern. However, a healthcare provider or a doctor cannot
base quality care solely on patient’s expectations.
A provider’s quality performance is by abiding with the regulations of Health Insurance
Portability and Accountability Act (HIPAA) which requires the “standards of procedures for
patient evaluation” to report services rendered to a patient for a quality (CMS for Medicare,
2015) in an indicative that provider performance is patient experience for procedure. However,
what patient care means to a patient for experience is able to get the treatment that helps to treat
and cure illnesses when is needed or the bits of help necessary to managed patient condition to
make improvement toward health. For the provision of ACA, managed care for a health plan is
not by a shared decision between provider and the patient for access to care and procedures.
Although it allows “health promotion and education for patient’s resources and health status”
only to follow regulations (Office of Legislative 2016) this shows that the outcome of patient
care is provider performance of procedure for healthcare coverage is the patient plan for having
health insurance.
The survey of 20 patients from Intravalley Health suggest that patient experience of
dissatisfaction is with the provider performance for clinical evaluation that was indicated for
procedures. However, provider performance for the procedure is not for the patient treatment that

a patient measure for a quality care. Quality care is the regulated procedure that the provider
performed for a payment system or a provider performance for a procedure is a quality care for
the patient experience. However, the regulated procedures are the experience for patient
dissatisfaction with the provider performance.
Therefore, the patient cannot truly measure an experience by regulated procedures for
quality of care. Although patients can measure physician recommendation of treatment or
therapy that treat or cure patient illness to indicate patient satisfaction with a care is a treatment
that works.
Patient satisfaction for the effect of health care services
Patient satisfaction is like a status report that describes things as they are or once were for
qualitative care. In this area, the differences between healthcare services and customer services
will be discussed. In retrospect to Mrs. Mellow her satisfaction lied with our customer services,
she asked which one of the services. She stated that Intravalley Health staff upheld a friendly,
professional environment, which she thoroughly appreciated. However, the allied health workers
are not the one making the decision for the type of care a patient receives. Patient satisfaction, as
an outcome of healthcare delivery, is an indicator of quality care. Lack of provider or allied
health worker thorough communication can created an unpleasant experience that reflects poorly
on healthcare services.
The patients have high expectations and with every healthcare experience, their
expectations increases for medical procedures. Our patients and customers have choices on
where to get their medical needs met. They expect clinical competence for the provider service to
makes the difference for patient satisfaction.

Health service for patient satisfaction
Health service is rated from patient’s interaction in which a patient has some leverage to
control the type of medical care that they are expecting from their provider. The notion is that a
physician or a provider should be available to render the care that a patient demands as part of
the treatment. However, a provider has to follow the protocols of clinical care. For example, a
physician cannot just write a prescription without a clinical evaluation. As in the case of Mrs.
Mellow, a provider cannot refill her prescription without a first-hand follow up on how the
medication is working. According to regulations, two weeks must be allotted in order to review
patient diagnosis and the effectiveness of a treatment.
Health service’s administration and insurance companies are also about the policies of
medical procedures to reimburse providers for their services. Patients indicate a satisfaction is
the provision of treatments that work well to cure a disease and better with managing a condition
for a quality care. However, physicians indicate the performance of the “clinical regulated
procedures are the Affordable Care Act (ACA) provisions for patient protection to improve the
outcome of care” (Congress, U.S., 2009) for the assurance of clinical care is the quality reporting
of patient experience for provider performance.
Quality reporting is the compilation of patient protection and affordable care act for
wellness and preventions program, health promotion activities, and services personalized to
improve and maintain patient health with risk assessments are the coordination of medical care
for the procedure. The medical procedure for a clinical patient evaluation is ongoing face-to-face
healthcare services for a quality care. According to the ACA, A.C., & Representatives (2010),
clinical evaluation is “the compilation of quality reporting that include the evaluation of existing
medical condition, the management of chronic disease; and medication adherence and

compliance are the initiatives for treatment or services under the plan or coverage for healthcare
services (p.19, a & b). Healthcare service does not work in the same regard as customer service
when it comes to paying for medical care is physician’s performance of regulated procedures
implemented for healthcare services in the Medicaid Medicare program.
The Center for Medicaid Medicare Services (CMS) for healthcare provider initiative is a
“shared savings program that meets the requirement specific to patient experience with a
different set of measures under ACA for Accountable Care Organizations (ACOs) to align with
the goal of providing the highest quality care to Medicare patients” (CMS 2015), the Medicare
set of measures by ACOs is to capture patient experience for timely care, provider
communication, and provider rating.
Nevertheless, patients desire to have a good rapport with their providers to communicate
their preference for care can lead to patient satisfaction of medical care for customer service.
However, there is no clear distinction between patient satisfaction and patient experience to
measure quality care for a customer service, because the terminology varies and are
interchangeable with the factors and procedures used to measure clinical care. Customer service
in the physician’s perception is the patient expectation of care that the physicians considered
unrealistic with the ACA provisions of care when compared to policies and procedures by
regulations are not negotiable in order to appease patient preference; the procedures are "doctor's
orders". Although equal effort has been underway within healthcare systems to address patient
satisfaction for physician performance in the delivery of medical care for quality care.
The establishment of a conceptual umbrella for the institution of quality, efficiency and
affordability of healthcare for a system that will pay for the provision of care services based on
the expectation of patient for quality care is one of the precursors to reform healthcare system for

patient experience will involve the metric system associated with improving provider care for a
"Triple Aim". According to Berwick, Nolan, and Whittington (2008), the Triple Aim developed
by Institute for Healthcare Improvement (IHI) is the pursuit of improving the experience of care;
improving the health of populations and reducing per capita cost of healthcare. Berwick et al.,
stressed the triple aims are interdependent without focusing on all three at the same level to
describe the goal include a focus on ethics, equity across populations, and specific strategies to
assure that the pursuit of one aim in isolation would not adversely impact the other aims. To
suggest the attempt is to measure the individual's satisfaction with their care is the result of what
individual experience on several levels.
Although, over the years, clinical care response describes the concept of patient
experience and satisfaction with procedure and treatment. Furthermore, Berkowitz et al, implies
that the regulatory clinical care for provider performance is “often use to measure patient
treatment for satisfaction are based on many factors that patient experiences before, during, and
after an episode of care, along with characteristics of the care environment” contributes to the
complexity of how to measuring patient satisfaction that linked to patient experience.
Patient experience according to Mayo Clinic GIM (2018), is patient visit for clinical
evaluation and medical procedure. The typical GIM patient visit include the evaluation processes
that depend on the complexity of patient medical issues for coordinating patient appointments
that will be efficient to be sufficient for procedures as possible. Mayo Clinic summarizes GIM
patient visit for procedures as follows:
Based on the medical information, GIM may preschedule tests and appointments. Initial
GIM appointment GIM care team will conduct an evaluation, including a physical exam
or recommend appointments with specialists. After the initial appointment, GIM care

team may schedule additional tests and consultations with one or more specialists. GIM
return appointment after testing and specialty appointments are done, GIM provider will
see patient to review results. This may be the final visit with GIM provider or additional
appointments may be scheduled. GIM will then send a summary of the patient visit to the
patient (Appendix II: YouTube video).
Allied health workers such as nurses, medical assistants, and patient advocates are the primary
caregivers in all healthcare environments to promote patient experience, which rallies to good
customer service.
Therefore, patient experience for health services is not the same with patient experience
for the clinical procedure. Maple (2017) stated that patient experience tends to equate with the
hospital stay is Hospital Consumer Assessment of Healthcare Providers and Systems survey
(HCAPHS). HCAHPS survey was originally designed to produce data about patients'
perspectives to enhance safety and accountability in health care does not measure the patient
experience in its entirety, however, it does measure key aspects of care for pain management and
the responsiveness of hospital staff due to financial incentives associated with HCAHPS for
arranged value-based care (HTML page) is what tend to equate to quality care for patient
experience in the outpatient setting for a procedure to indicate HCAHPS is not the true measure
of patient experience for provider performance of procedure and doing so is a departure from a
practical approach to understanding patient experience for a procedure. As well, HCAHPS
cannot measure the complexity of a procedure for a patient care.
The fact shows there is more to learn about the patient experience for care expectation of
provider performance for clinical procedures. In clinical setting for medical procedures,
measuring true patient experience and care value is more complex because the metrics must

include provider performance, assessment of teamwork for patient evaluation, communication of
health services for promotions and options, connection of services for healthcare coverage,
caregivers, and families for related services pervade all the aspects and the environments
associated with patient experience for health service and medical care.
Conclusion
Research has shown that patient experience is tied to provider performance for a medical
procedure, as well hospital service for patient care, and others services for administrative
procedures combined to render quality of care for the delivery of healthcare services, make it
difficult to know which parts or dimensions of care for the patient experience. Patient satisfaction
is usually positive for treatment that works to help the patient improve health to dismiss patient
experience for a quality of care is a myth. Siegrist (2013) describe a survey of patient experience
is a contest, patients who fill out surveys are generally unhappy with their care for a primary
contest of a popular service and quality of care are not related to patient satisfaction because
patients cannot evaluate the quality of care that is being delivered, although patient satisfaction
may be the case in non-health care industries for customer service.
However, it is decidedly not true in medical care that requires wait time for coordination
of health service and clinical care for provider performance with procedure such as, a clinical
evaluation of the patient for surgical operation cannot be a factor into patient experience. As well
patients expect the providers to be able to coordinate their care for correlated services are the
system of referral and pharmaceutical for patient treatment are related to wait time for the
delivery of medical care or health care services. A “2014 study in the American Journal of
Managed Care found that longer wait times correlated with negative perceptions of care and
lower levels of patient satisfaction” (Weber, 2017, p.2). This is true, because, quality of care is

time coordinated between the health services and medical care for the provision of treatment by
providers that comply with the procedure for HIPPA regulation and the Affordable Care Acts.
The option is to design a system of measuring patient satisfaction by assessing treatments
results and physician-patient interaction. Patients are usually satisfied if the patients receive a
treatment at the time that a treatment is needed as well if the treatment works to improve patient
health. Measure patient experience and satisfaction can be accomplished by designating a
patient-family advisory advocate who focuses on a patient needs for health and family concern
for a patient recovery from an illness.
Recommendation
The recommendation is having a Patient-Family Advisory Advocate Board (P-FAAB) for
cross-section decision making. The board should consist of ten (10) senior leader members that
include:
 Two (2) physicians that will be visiting patients prior to the scheduled clinical procedures
for a verbal briefing of writing procedure as prior instruction for the expectation of
provider performance for a procedure for a patient understanding. The good best practice
of a provider performance of a quality care is patient understanding of a procedure for
patient satisfaction.
 Four (4) nurses to follow up after patient clinical procedure for an update on how the
patient feels about the procedure, and if the procedure help to relieve patient symptom for
good or bad, and to get patient review of the provider for performing a good job with
rendering of a quality care is patient care for a treatment.

 Two (2) healthcare administrators that collect data from the patient in conjunction with
provider performance for the adjunct to a process of following the regulation that
compliance with policy for procedures.
 Two (2) allied health workers or social workers that meets quarterly or every three
months with patients and family who file complaints about clinical care or service
procedures to include them in decision making for improvement.
This will allow for feedback on Intravalley Health overall services and future needs that
include the followings: (1.) a disclosure that a decision needs to be made (2.) a formulation of
fairness of partner’s participation and interaction (3.) a presentation of care options for a patient
for a provider choice (4.) a well inform of provider procedure verbally as well in writing the
benefits and risks for a patient understanding and consent, (5.) an investigation to patient's
understanding and expectations of care for a quality, and (6.) a negotiation of reaching a shared
decision for patient participation in provider performance of procedure and follow-ups.
A prototype of guidelines of patient expectation for provider performance is participation
in decision-making process for a procedure that can be measure for patient experience is patient
participation for procedures. As well to include new innovation of patient experience for
customer service. Some researchers have proposed a “Consumer Insights Survey” (Carrus et al.,
2015) as criteria for comparing the patient experience to consumer survey that will not be
measured by clinical or medical procedure for health care outcome of a quality care, but from
several sources associated with facility design and atmospheres for pleasing and pleasantness,
good staffs rapport, nice communications system, and the administrative availability to correlated
care and services for timely manner of rendering quality care to patient for a satisfaction data
(Appendix III).

References
ACA & REPRESENTATIVES, U. H. O. (2010). Compilation of Patient Protection and
Affordable Care Act. Retrieved from
http://legcounsel.house.gov/Comps/Patient%20Protection%20And%20Affordable%20Ca
re%20Act.pdf
Berkowitz, B. (2016, January 31). “The Patient Experience and Patient Satisfaction:
Measurement of a Complex Dynamic” Academic Library Journal of Issues in Nursing.
Retrieved from https://www.questia.com/library/journal/1P3-4097535131/the-patient-
experience-and-patient-satisfaction-measurement
Berwick, D., Nolan, T., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health
Affairs, 27(3), 759-769
Carrus, B., Cordina, J., Gretz, W., & Neher, K., (2015). Measuring the patient experience: Lesson
from other industries. Retrieved from https://healthcare.mckinsey.com/measuring-patient-
experience-lessons-other-industries
CMS Center for Medicare. (2015). CAHP survey for accountable care organization Participating
in Medicare initiatives. Retrieved from http://acocahps.cims.gov/content/default.aspx
Congress, U. S. (2009). HR 3590: Patient Protection and Affordable Care Act. In 111th Congress
(Vol. 2010). Retrieved from https://www.congress.gov/bill/111th-congress/house-
bill/3590
Federal Register. (2010). Medicaid program: an Initial core set of health quality measure for
Medicaid-eligible adults. Retrieved from http://www.gpo.gov/fdsus/pkg/FR-2010-12

Maple, W. (2017, January 31). Going Beyond HCAHPS to Improve Patients' Experience.
Retrieved from https://www.hhnmag.com/articles/8011-going-beyond-hcahps-to-
improve-the-patient-experience
Mayo Clinic.org. (2018). Services. Retrieved from https://www.mayoclinic.org/departments-
centers/general-internal-medicine/minnesota/services
Mayo Clinic GIM. (2018). Typical Visit. Retrieved from https://youtu.be/JaURTE14dMA
MFMER, Mayo Foundation for Medical Education and Research. Departments and
Centers for General Internal Medicine. Retrieved from
https://www.mayoclinic.org/departments-centers/general-internal-
medicine/minnesota/services/typical-visit
Office of the Legislative Counsel, U.S. House of Representative. (2016). Compilation of Patient
Protection and Affordable Care Act. Retrieved from
http://housedocs.house.gov/energycomerce/ppacacon.pdf
Siegrist Jr, R. B. (2013). Patient satisfaction: history, myths, and misperceptions. Virtual Mentor,
15(11), 982. Retrieved from http://journalofethics.ama-assn.org/2013/11/mhst1-
1311.html
Weber, S. (2017, Jan 9). Enhancing the patient experience with exceptional customer service.
Retrieved from www.physicianspractice.com/patient-relations/enhancing-patient-
experience-exceptional-customer-service/page/0/1

Appendix I

Appendix II
Mayo Clinic GIM video

Appendix III
*Source: Consumer Health Insight Survey, 2013 as cited in Carrus et al., 2015, p.6.

Research paper

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Research paper

Similar to Research paper (20)

More from Modupe Sarratt

More from Modupe Sarratt (20)

Recently uploaded

Recently uploaded (20)

Research paper