Ever played “Pin the Tail on the Donkey” as a kid? You know, that hilarious game where you’re blindfolded, given a dizzying spin, and then expected to pin a tail on a donkey without impaling the wall… or a friend? 

Sometimes, navigating the improvement of your agency’s Home Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores can feel eerily similar. With the roll out of Home Health Value-Based Purchasing (HHVBP), care teams lacking a full understanding are likely to miss out on pivotal financial and competitive opportunities in which above average scores equip their agency with. 

Yesterday’s Perception, Today’s Challenge

Since the implementation of the HCAHPS survey in 2010, care teams have been consistently educated about the pivotal role of patient satisfaction in improving HCAHPS scores. The message from and to home health leaders has been unambiguous: prioritize patient satisfaction. Which made sense over the years as it’s one of the five measures with the most sway of influence in a time frame where an agency’s rating or score had no financial repercussions or benefits (excluding the value referral sources place on the different measures). However, in tomorrow’s world of value-based care and HHVBP, it’s crucial to note that HCAHPS isn’t solely about patient satisfaction, as the majority of the questions center on patients’ recollections of their experiences while receiving home health care.

Great Clinician, Unclear Target

Consider Sarah, a devoted home health nurse. In her efforts to keep patients happy, she often assumes there is minimal need to discuss setting up the home safely or addressing over-the-counter medications with patients who lack rugs in their walkways and seem well-informed about their prescription drugs. As a result, she often sidesteps these topics, fearing she might upset patients by making them feel insecure. Sarah thought that prioritizing patient contentment would naturally enhance HCAHPS scores. However, the results didn’t meet her expectations.

Even with her undoubtedly top-tier care, Sarah’s focus on satisfaction led her patients to provide the best possible answers  for 2 out of the 5 HCAHPS VBP measures (rating of care and willingness to recommend), while the other 3 composite measures suffered (care of the patient, communication, and specific care issues).

Since all 5 measures are equally weighted to make up HCAHPS’ 30% of the HHVBP total performance score, the 3 low performances dragged down the total performance opportunity that Sarah is more than capable of achieving if she simply had clarity on how her patients were evaluating the care she provided.


Deciphering Patient Experience 

Patient experience is a comprehensive concept when you dig into what is asked on the HCAHPs questionaire. It encapsulates every interaction a patient has, from understanding the services they will receive to communication about visits, to medication, to their willingness to refer a friend or family member to the agency who provided care, and more. While patient satisfaction is the ultimate goal, the patient experience outlines the entire journey—a journey that most of the HCAHPS questions aim to assess.

By familiarizing home health clinicians with the subtleties of HCAHPS questions and emphasizing the multifaceted nature of the patient experience, the genuine target is highlighted. With this understanding, home health professionals can refine their strategies to align with the actual criteria on which they’re evaluated. 

Experience is an Indicator of Satisfaction

In the realm of home health care, an outstanding patient experience lays the groundwork for trust. When patients feel engaged, appreciated, and understood within their home environment, they are more likely to stick to care guidelines, express their concerns, and place trust in their caregivers. This not only boosts satisfaction but can also lead to better health outcomes and higher HCAHPS scores.

Taking Proactive Steps

For those leading or influencing home health agencies, a shift in focus is essential. Make sure your teams recognize the significance of patient experience within the HCAHPS framework. Equip them with the tools and knowledge to enhance this experience. By doing so, you ensure that your team can hit the bullseye with accuracy.

Pulling it All Together

In the realm of value based home health care—where patient outcome and satisfaction are further driving an agency financial performance—the goalpost is not merely to deliver an exemplary experience but to ensure it remains indelibly imprinted in patients’ memories. To do so, its vital to equip clinicians with the tools they need to leave the feeling of playing ‘Pin the Tail on the Donkey’ aside. 

By providing clinicians with further education on HCAHPS’ intended goals and tools to harness the power of creative storytelling, care teams can help drive memorable experiences that not only amplify patient engagement and increase the potential to improve HCAHPS scores, but also ultimately contribute to better patient outcomes and a reduction in preventable hospitalizations.

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