The third problem area is the potential for misuse of the patient experience scores. Some administrators have used this metric to credential emergency physicians and to designate them with regard to quality. While the patient experience is one of the dimensions of quality, it is only one of the six designated by the federal government; others include clinical effectiveness, patient safety, care coordination, and efficiency. Guidelines need to be developed so that any ED PECS scores which are tied to individual physicians may be interpreted by medical group and hospital leaders in an appropriate manner.

Robert E. O’Connor, MD, MPH, FACEP

Professor, Chair, Physician-in-Chief, Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia; Emergency Physician, Culpeper Regional Hospital, Culpeper, Virginia

The challenge that arises when discussing “financial incentives” for patient “satisfaction scores” is that most emergency physicians view these programs with caution and skepticism. Everyone has heard about colleagues who have been financially penalized or have even lost their contracts based on “poor” survey results. Most emergency physicians question the validity of any survey that has so much importance attached to it, yet evaluates only 10 percent of discharged patients (admissions are excluded), with a 10 percent response rate, representing 1 percent of patients seen. Within this context, CMS is piloting the ED-CAHPS survey, which has drawn a lot of attention from the emergency medicine community.

In an effort to measure and promote care that is patient-centered, CMS has been required by the Patient Protection and Affordable Care Act of 2010 to implement payment and public reporting programs using data collected from CAHPS. Three such programs that are fairly well developed are the Hospital Value-Based Purchasing and Hospital Compare Programs that have been developed using data from HCAHPS, and the Physician Compare program, which uses data collected from the CAHPS Physician Group Survey. Efforts to use CAHPS surveys to assess a wide array of health care entities are currently underway and includes nursing homes, Health Insurance Exchanges, behavioral health, Accountable Care Organizations, and dialysis centers, to name a few.

The CAHPS surveys are designed to focus on the patient care experience while deemphasizing patient satisfaction, which is a subtle, yet crucial, distinction. Two examples, taken from the ED-CAHPS pilot, illustrate this. Instead of asking how satisfied the patient was with the time it took to be seen, the survey asks “When you first arrived at the emergency room, how long was it before someone talked to you about the reason why you were there (Less than 5 minutes – 5 to 15 minutes – More than 15 minutes)? The survey also measures global ratings such as “Using any number from 0 to 10, where 0 is the worst care possible and 10 is the best care possible, what number would you use to rate your care during this emergency room visit?” The ED-CAHPS survey is intended to allow for comparisons across a wide variety of hospitals, locations, medical conditions, and insurance types.