3 Reasons Health Systems Should Invest in Improving Patient Experience
Ruthann Russo - Integrative Population Health Management - White Paper Part 1
1. Well-being. Performance.
Table of Contents
Introduction.................1
Measuring
Inpatient Hospital
Satisfaction..................2
Integrative Health
Modalities.....................4
Patient Satisfaction
with Integrative Health
Modalities and
IHM Interventions.......5
Conclusion....................6
Integrative Health and HCAHPS:
Improve Inpatient Satisfaction and
Increase Reimbursement
35.1 million inpatient hospitalizations in the United States in 2013 at a cost
of $361.5 billion accounted for 31% of the nation’s total healthcare spending.1
With spending continually rising, healthcare leaders need cost effective ways
to improve quality of care and patient satisfaction while also increasing
reimbursements. By implementing clinically proven and inexpensive Integrative
Health Modalities (IHM) as a supplement to conventional medicine, healthcare
leaders can achieve these fundamental goals. This paper addresses the benefits
of an inpatient, hospital-based Integrative Health Modalities (IHM) program
for increasing hospital HCAHPS scores and therefore hospital reimbursement
through improved patient satisfaction.
In 2008, the Centers for Medicare and Medicaid Services (CMS) began measuring
inpatient satisfaction using the Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) survey. Using HCAPS scores, CMS rewards
hospitals through increased reimbursement for enhancing patients’ experiences
of care. Patient satisfaction is a primary hospital metric, with increased scores
generating several potential benefits. As a result, it is crucial that healthcare
systems determine safe, effective, and structured methods for improving patient
care without significantly impacting their current budget.
Patients who receive Integrative Health Modalities (IHM) in addition to
conventional treatment for the same condition report higher satisfaction with
their care than patients who only receive conventional treatment. Based on
Medala Group’s analysis and evidence-based research, 89% of hospital inpatients
can benefit from the use of Integrative Health Modalities (IHM).2
Given the
numbers of inpatient hospitalizations and the economic incentives associated
with them, IHM is a proven method to increase success rates.
In a 2009 study involving interviews of hospital chief executive officers about
the impact of IHM at their hospitals, the CEOs identified pain reduction and
consequently, improved patient satisfaction as the most common benefits
Part 1 of a 3 Part Series on Integrative Health
Ruthann Russo, PhD, MPH, LAc
www.medalagroup.com
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
of IHM.3
This study, in addition to the proven impact of IHM therapies on patient
satisfaction and the relatively low cost of implementation, demonstrate that investing
in IHM is a low risk with high return probability for hospital administrators. The line
of impact is clear: Medala Group’s IHM therapies offered in inpatient settings may
significantly increase HCAHPS scores, leading to overall increased hospital revenue as
illustrated in Figure 1.
Figure 1. The impact of IHM therapies on inpatient hospital revenue.
MEASURING INPATIENT HOSPITAL SATISFACTION
The HCAHPS survey is a national measure of patients’ perceptions of their hospital
experience, including their pain management, hospital noise levels, overall comfort, and
whether or not the patient would recommend the hospital to another potential patient.
The hospital-specific data from HCAHPS is shared via the Hospital Compare website,
with three basic goals:
1. The survey produces data that allow comparisons of hospitals on issues
that are important to healthcare consumers
2. HCAHPS provides economic incentives for hospitals to improve quality
of care
3. The survey increases accountability of health care providers4
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
HCAHPS accounts for 30% of a hospital’s value-based purchasing (VBP) score, which is
used to determine the amount of incentive payment each hospital receives. Hospitals
must determine an effective and proven means of improving patient satisfaction
to increase their revenue and reimbursements, as well as improve overall care and
accountability. To achieve these goals, HCAHPS asks 18 core questions of patients
after their discharge from the hospital. These questions ask the patients to rate (1)
quietness, (2) pain management, (3) overall hospital experience, and (4) whether
they would recommend the hospital. In most analyses, the second, third, and fourth
categories carry the highest weight; they are also the categories that are most
positively impacted by the structured use of IHM.
As noted, effective pain management is a key metric for HCAHPS patient satisfaction
measures. The experience of pain involves both a physical and an emotional
component, often expressed in the form of anxiety and/or depression. When patient
interventions can address all of these components of pain (physical sensation, anxiety,
and depression), they are likely to produce higher HCAHPS scores. IHM prior to surgery
has been found to reduce anxiety, pain and narcotic requirements, which in turn leads
to increased patient satisfaction. The table below illustrates eight IHM practices that
effectively manage pain, anxiety, and depression. To the extent that one or more of
these modalities is available and used adjunctively for a patient during hospitalization,
patient satisfaction is likely to be higher than if the modalities were not available.
Table 1: IH Modality for Pain, Anxiety, Depression
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
Importantly, hospital administrators need to make data-driven decisions for their
hospitals. To evaluate IHM results, they need a deep understanding of best practices
for IHM, the impact on patient satisfaction and overall health, and they need to have
the corresponding data in place to prove it. Data displaying items such as patients,
modalities employed, frequency, and duration would be essential for both short and
long-term analysis. Given the efficacy and low investment required to implement
IHM, it is in the best interest of hospitals and healthcare systems to develop new IHM
programs or expand existing programs. Most importantly, it is in the best interest of
the patients they serve.
INTEGRATIVE HEALTH MODALITIES
Integrative Health Modalities (IHM) include practices that focus on the interactions
among the brain, mind, body, and behavior with the intent to use the mind to affect
physical functioning and promote health, as described by the National Institutes of
Health (NIH). Examples of these types of IHM include meditation, guided imagery,
progressive relaxation, yoga, breath-work, Qi Gong, Tai Qi, movement therapies,
hypnosis and biofeedback. The Bravewell Collaborative has identified defining
principles of Integrative Health, which parallel patient-centered care, noted in the table
below:
Defining Principles of Integrative Health & Medicine
• Patient and practitioner are partners in the healing process
• Mind, body, spirit, and community are considered in the treatment
process
• All relevant healing sciences are used
• Together with treatment, health promotion and illness prevention are
paramount
• Care is personalized to address the individual’s unique needs and values
42% of hospitals provide some form of IHM to patients, and 21% of hospitals provide
IHM services in the inpatient setting. 5% of survey respondents report that they are
planning to expand services to the inpatient setting in the future.5
The Bravewell
Collaborative identified mindfulness-based stress reduction, meditation, yoga, Tai Qi/
Qi Gong, and journaling as the most common IHM interventions. Additionally, 76.2% of
patients who received IHM services for pain in the hospital felt their pain was improved
as a result of the IHM therapies.6
In addition, 72% of these same patients responded
that they were taught helpful practices to self-manage pain, and that they continued
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
to use the practices after discharge to manage their pain. This ability for the patient
to practice the therapies independently increases patient empowerment and possibly
overall health.7
These findings both support increased levels of quality of care as well as
patient satisfaction and engagement.
PATIENT SATISFACTION WITH INTEGRATIVE HEALTH MODALITIES
AND IHM INTERVENTIONS
83% of hospitals offering IHM services collect data about patient satisfaction and the
correlation to those services.8
Patients who received Integrative Health Modalities in
addition to their regular treatment had higher satisfaction scores than similar patients
who did not receive IHM therapies.9
Further, a study from the University of Michigan
found that 61% of patients rated their IHM care as excellent or the best ever.10
92%
of patients using IHM services were at least moderately satisfied with their IHM care
compared to being 44% moderately satisfied with their conventional medical care.11
Importantly, health-related quality of life was significantly improved for patients with
chronic conditions after being treated with IHM therapies leading to lower readmission
rates, as well as overall improved well-being and more effective pain management.
Specific supplemental usages of IHM interventions for medical treatment have shown
to be efficacious for patient satisfaction, including pain reduction, lower readmission
rates, and overall comfort for diverse areas. Patients who received guided imagery,
touch therapy, and music therapy prior to and following surgery had higher satisfaction
scores than similar patients who did not receive these therapies.12
In a Cleveland Clinic
study, the use of guided imagery prior to surgery was found to reduce anxiety, pain
and narcotic requirements and increase patient satisfaction.13
This study was replicated
with coronary artery bypass patients over a decade later with similar findings including
a significant reduction in patient length of stay. Similar IHM services in a cardiac
surgery program were found to decrease anxiety, pain, and length of stay and increase
patient satisfaction. IHM was found to have a positive impact on patient satisfaction in
research that involved hospital bone marrow transplant patients. IHM was also found
to reduce blood pressure, decrease anxiety and pain and increase patient satisfaction in
thoracic surgery patients.
Similarly, there are well over 70 current and past studies qualitatively and accurately
identifying IHM interventions as effective for improving pain, showing IHM as an
effective and efficient means of improving patient care and quality of life. 65% of
hospitals responding to the Samueli Institute (2010) survey offer therapies for pain
management. 75% of IHM centers report clinical success with chronic pain.14
The
most common modalities used for chronic pain in these centers were yoga, massage,
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
meditation, and relaxation. Likewise, the most common interventions for acute pain
were massage, relaxation, acupuncture, and breathing, showing that IHM provides
lasting pain relief management to patients.
Prior research has also found that IHM practices increase patients’ sense of
empowerment and engagement in their own care, leading to a greater feeling of
control and a more positive perception of their environment. It is important that IHM
has lasting effects on patient satisfaction—this could help increase patient retention
as well as improve the rate of recommendation from healthcare consumers. Overall,
these components lead to improved HCAHPS scores and generally improved patient
well-being.
CONCLUSION
A positive impact on HCAHPS scores is a motivating factor for hospital leaders to
consider providing IHM interventions as an adjunct therapy in the inpatient setting.
There are both qualitative and economic effects when HCAHPS scores are high. And
as shown, one of the most efficacious and cost effective ways of improving patient
satisfaction in the three primary areas (overall experience, pain management, and
whether a patient would recommend the hospital) is providing Integrative Health
Modalities as significant supplements to conventional care.
Ultimately, a positive relationship between IHM services and HCAHPS scores benefits
all patients, as well as the hospital’s care system as a whole. When IHM services are
provided to patients in the hospital, these services can increase patient satisfaction,
which would be reflected in the most important categories of the HCAHPS survey.
When IHM services for inpatients have a positive impact on HCAHPS scores, hospital
reimbursement also increases. With this potential for increased revenue, healthcare
systems should feel empowered to implement IHM programs in a structured, strategic
way to not only positively impact the bottom-line, but to support patient-centered
missions for all healthcare system patients and individuals in the community.
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Well-being. Performance.
Integrative Health and HCAHPS: Improve Inpatient Satisfaction and Increase Reimbursement
References
1
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2
Maryland Health Services Cost Review Commission, 2013 Inpatient Discharge Data Set.
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4
Centers for Medicare and Medicaid Services. (2012). HCAHPS: Patients’ perspectives of care survey.
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HospitalQualityInits/HospitalHCAHPS.html.
5
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Journal of Alternative and Complementary Medicine, 7(1), S93-S101.
8
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Myklebust, Pradhan & Gorenflo, 2008.
11
(Stewart, Weeks, & Bent, 2001)
12
(Casida & Lemanksi, 2010).
13
(Dusek, Church, Strong, Grass, & Fazio, 1997).
14
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