What is the CAHPS survey?
The Centers for Medicare & Medicaid Services (CMS) conducts the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The CAHPS survey is administered to randomly selected Medicare beneficiaries who are enrolled in a Medicare Advantage medical or prescription drug plan. While some of the questions on the CAHPS survey are plan-specific, others pertain directly to the care a patient receives in physician offices, including their perception of communication with doctors and coordination of care. The CAHPS survey period runs from March until June.
Responses to the CAHPS survey are grouped together to make up nearly a fifth of a health plan’s total CMS Star Rating. CMS also puts greater weight on CAHPS-related Star measures when compared to several other Star measures.
How does a health plan's Star Rating impact members?
The biggest motivator to improve the Star Rating for our health plans is our members. In addition to our members being more satisfied with the care they receive from Independence network providers, health plans that earn at least a Four-Star Rating qualify for federal bonus payments, which by law, must be returned to the beneficiary in the form of additional or enhanced benefits, such as reduced premiums or cost-sharing (e.g., copayments) or expanded coverage.
How can you impact a member’s experience?
There are several ways that a member’s experience can be affected, both by Independence and in your physician office. We fully acknowledge that you are already working hard to provide exceptional care to our members. To continue improving performance, Independence wants to collaborate with you to maximize the member’s experience in the physician office.
As part of this effort, Independence wants to share the specific areas in which CMS is measuring performance. Many of these areas can be addressed through expectation setting. Providing patients with specific timelines for scheduling appointments, receiving test results, and general communication plans can greatly impact a member’s experience and perception of their health.
There are several categories in the CAHPS survey that you directly impact. In addition to highlighting these areas, we have included brief reminders on best practices for you to consider.
- Providers discuss prescription medications patients are taking. Discussing prescription medications with your patients will help them to better understand their options for filling prescriptions (e.g., mail order), correct dosage, side effects, and how different medications can interact. Information on how the completion of prescription drug prior authorization forms improve member satisfaction can be found here.
- Getting appointments with specialists as soon as patients need them. Some patients believe that they must see a specialist urgently when the need for care or consultation is not always urgent. Please establish a reasonable time frame for when patients should expect to see a specialist.
- Getting appointments for checkups as soon as patients need them. Please let your patients know that if their condition is urgent, you will ensure they are seen as quickly as possible.
- Patients see their provider within 15 minutes of the appointment time. When your patients check into the office for their appointment, please notify them if the office is running behind. By letting members know when they arrive if they should expect a wait, you can hopefully alleviate any concerns patients may have with an extended wait time.
- Physician offices follow up with patients to give test results after ordering a blood test, X-ray, or other test. Set expectations with your patients about when they should expect to hear from your office regarding their test results.
- Personal physicians help their patients manage their care and stay informed. Staying up-to-date on visits to specialists, hospitalizations and care coordination are important aspects to keeping your patients as healthy as possible. Communicate with your patients around changes in their health status, including post hospitalization. Staying informed can also reduce patients’ out-of-pocket costs by removing any unnecessary duplication in tests or services.
For more information
Independence Medical Directors are focused on improving the health of our members and the quality of care provided. If you have questions about this information or would like to know more about the CAHPS survey, please email Heidi Syropoulos, M.D. You can also read more about the CAHPS survey on the CMS website.