Three versions of the survey have been field tested, one for patients discharged to the community, one stand-alone version for patients admitted to the hospital, and a version for patients admitted to the hospital that will be administered as a supplement to the existing HCAHPS survey.

But does the patient experience correlate with quality? Results have been mixed. Patients who report a better experience tend to understand and comply with treatment regimens. Effective communication and trust in the physician results in a better patient experience and should be reflected in better survey scores. Feedback to providers is crucial. In one example, physicians who were initially deemed to be poor communicators with poor patient compliance could achieve improvements in both areas through communication skills training. In recognition of its importance, the American Board of Emergency Medicine has added patient feedback as a required component of the Assessment of Practice Performance component of its Maintenance of Certification.

Higher HCAHPS Scores have also been associated with better CMS clinical process of care measures, improved patient safety (fewer infections, fewer decubitus ulcers), and possibly better efficiency. Hospitals with lower HCAHPS scores were able to improve their scores by implementing programs that focused on the patient experience.

For ED-HCAHPS to be truly effective, the information that is gathered should give emergency medicine the opportunity to improve the resources that we oftentimes lack in the form of facilities, the admission process, staffing, and equipment. With the right questions, we will be able to gain a better understanding of how admission delays, cleanliness, and interpersonal interactions impact the patient experience. We should welcome our patient’s perspectives on hallways, crowding, and boarding and use the results to address all three as institutional problems.

This leads to my conclusions. The only financial incentives that I favor are ones that require that hospitals broadly administer the survey and report their results through the ED-HCAPS program. This will ensure that data elements are widely collected, and that the results are robust and comprehensive. I do not favor incentives based on score comparisons, as many factors contributing to these scores are beyond physician control. Instead of being a performance end point for the individual emergency physician, these scores should provide health care entities and physicians with the information we can collaboratively use to provide a better patient experience.

Rebecca Parker, MD, FACEP

Attending emergency physician, Centegra Health System, McHenry and Woodstock, Illinois and Presence Covenant Medical Center, Urbana, Illinois. Vice President, EmCare North Division. President, Team Parker LLC, Consulting Group Coding, Billing, and Compliance, Clinical Assistant Professor, Texas Tech El Paso Department of Emergency Medicine