What is your stance on financial incentives for emergency department Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) scores?
Click the candidates to read their responses.
Jay Kaplan, MD, FACEP
Robert E. O’Connor, MD, MPH, FACEP
Rebecca Parker, MD, FACEP
Jay Kaplan, MD, FACEP
Director of Service and Operational Excellence, CEP America; Attending Physician, Department of Emergency Medicine, Marin General Hospital; Medical Director, Studer Group
The short answer is “not ready for prime-time.”
The Patient Experience of Care Survey (PECS) (now no longer called ED-CAHPS) is currently in its second draft; it is not going away—it needs to be modified. When the survey was in its initial development, I made an attempt through Art Kellerman, MD, to have input in its design. Despite ACEP sending recommendations to them, I never felt that we had adequate input. At the Leadership and Advocacy Conference in Washington, D.C., this past May, Dr. Patrick Conway, chief medical officer of the Centers for Medicare & Medicaid Services (CMS), spoke to us. When he was finished, I ran after him and obtained his contact information. I then connected with the CMS office and, with the further assistance of Barbara Tomar in our D.C. office, had a follow-up call with the CMS project team. I and a number of knowledgeable ACEP members and staff are now working to make more concrete suggestions to the CMS project team so that the survey will more accurately serve its purpose, which should be to improve patient care and clinical outcomes for patients. We are attempting to 1) decrease the number of questions on the survey so that a higher percentage of patients will complete it; and 2) modify the questions so that they are applicable to the ED rather than to the inpatient setting, e.g. the question “How often did the doctors and nurses do everything they could to help you with your pain?” is inappropriate in the setting of the opioid epidemic we are experiencing. I am hopeful we can revise the final accepted survey.
There are a number of other issues with regard to creating financial incentives using ED PECS. The first is the survey itself. The second major area of concern is the methodology by which it will be implemented. While many emergency physicians rail against Press Ganey & Associates because they are the largest and best known patient satisfaction survey company, they at least typically survey several hundred patients per month. In contrast, many of the other companies (including the company currently used at my hospital) usually survey as little as 100 patients a quarter. If ED patient satisfaction is to be used as any sort of incentive, a statistically valid sample size must be obtained for each physician. We as physicians are data driven, and give us metrics which we can believe and trust and we will change and get better. Without data it becomes smoke and mirrors. The minimum number of returned surveys needed is recognized to be no less than 30 surveys, and ideally 50. This number should be captured within a short enough time so that physicians who want to enhance their scores can see that their specific actions are improving the patients’ perceptions; ideally this should be 50 surveys per quarter. With the current practice, it would take two years in most ED’s to get an adequate sample size for each individual provider, and that is absurd. The methodology at present is terribly flawed.
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