The Value of Patient Experience

Have you read the CMS 752 page “Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 3 and Modification to Meaningful Use in 2015 through 2017” rule yet? In last week’s blog post, Dr. Terry Ketchersid confirmed the 90-day attestation period for 2015 Meaningful Use (MU) reporting and the simplification of measurement objectives for Stage 2 MU. The Final Rule from the CMS includes a plan to consolidate the EHR incentive programs as part of the Merit-based Incentive Payment System (MIPS). In the next few years, meaningful use will be replaced by meaningful value.

MIPS includes payment to providers for value-based performance in clinical care quality and efficiency. MIPS is likely to have performance or measurement calendar years followed by adjustments in payments in subsequent years. Performance-based payment or penalties are likely to be significant: +/- 4% in 2019 payment year and up to +/- 9% in payment year 2022.

While clinical data is available as never before, is clinical quality only about lab data and process metrics? Does the sum of your clinical data measure up to the great delivery of health care for patients? Recently, I heard a presentation from Claudiu Coltea, vice president of customer experience for Fresenius Medical Care, and I was amazed to hear about quantitative data on patient experience. With a background in actuarial mathematics and business administration, Claudiu’s previous work includes building a best-in-class global customer experience program for The Gallup Organization and serving as senior vice president of customer strategy at Citigroup. So he knows a lot about customer experience that he has translated into patient experience.

I asked Claudiu to write about how patient experience is part of the value-based care equation. Here’s Claudiu’s advice about the value of patient experience to your practice:

“For many health care organizations, patient experience has had the dubious dishonor of living ‘outside’ the world of customer experience. As many physicians anecdotally say, ‘I am in the business of doing the right thing, not the nice thing.’ For decades, other industries like banks, hotels and airlines have been competing on service to attract and keep customers while aggressively researching and implementing ways to improve their customer experience. At the same time, those in health care often operate as though they are ‘exempt’ from doing so.

One of the primary reasons health care organizations steer away from focusing on patient experience is the notion that delivering on medical outcomes has little or nothing to do with a high-quality patient experience. But a few have paid close attention to what their customers, the patients, want and made deliberative decisions to act on that feedback. The results from these early pioneers in patient experience are profound and should make us rethink the way we deliver care and, more importantly, redefine what ‘quality’ of care means from a patient’s point of view. The findings* suggest that patient experience not only improves customer satisfaction but also positively impacts medical outcomes and safety.

For example, in the past, The Cleveland Clinic, like many prestigious health care organizations, focused solely on medical outcomes. In 2007, the Cleveland Clinic organization recognized that much of the research, effort and work designed to improve clinical outcomes did not have the intended impact to patients’ perceptions, and even health. According to CEO [Delos] Cosgrove, ‘patients were coming to us for clinical excellence, but they did not like us very much.’ The hospital system realized that it could not count only on medical outcomes to continue attracting patients because, for many people, the anticipated patient experience is more important than medical excellence. So the clinic went through a transformation, recognizing that patient experience was a significant issue. The organization changed very quickly. Concerns that patient-centered initiatives would impact medical outcomes were nullified, and the clinic significantly improved its position in the HealthSystem Consortium ranking on quality, safety and even efficiency – all as a result of initiatives designed to improve patient experience.

Improving patient experience is difficult, if not impossible, without a deep understanding of the key elements most critical to patients. The Cleveland Clinic used the approach to deeply understand their patients’ needs through surveys, studies and patient input. In other words, measuring and monitoring the experience. Because patient experience is rooted in emotion, it is often thought of as a ‘soft’ science, if a science at all. But, it is precisely the opposite. In the same way physicians and health care providers utilize empirical evidence and data to enhance treatments and medical outcomes, using empirical measures for patient experience can positively impact a patient’s health. In fact, the New England Journal of Medicine** found that ‘overall satisfaction with care was positively correlated with clinical adherence.’ This is perhaps one of the largest challenges for nephrologists, since a patient’s ability and willingness to follow treatment plans have significant health effects.

In the world of kidney-related care, nephrology health providers have a responsibility to assess and address the patient experience. Health care is, after all, a service. World-class service organizations, including those in health care, are proving that those who ultimately ‘win’ are those who can assess, measure, and act on the emotional drivers of their patients. For those living with kidney disease, those drivers impact much more than emotions; they impact patient longevity and quality of life.”

If you measure and address patient experience in your practice today, send us a comment about how you do it.

Claudiu Coltea is the vice president of customer experience for Fresenius Medical Care. He has led multiple senior management teams, building best-in-class global customer experience programs and serving as senior consultant and subject matter expert with The Gallup Organization and senior vice president of customer strategy at Citigroup. Coltea holds a Bachelor of Science degree in actuarial mathematics, and a Master of Business Administration degree in strategy from the University of Michigan, Ann Arbor.

Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers. 

* Harvard Business Review, May 2013, “Healthcare’s Service Fanatics”
** The Patient Experience and Health Outcomes, NEJM January 2013