Closing the Quality Gap: Patient Experience

Medicare senior patient meeting with provider to discuss her health.

What is Patient Experience?

Patient experience (PEX) encompasses all patient interactions with a healthcare system, including care from health plans and from doctors, nurses, hospital staff, physician practices, and other healthcare facilities.

How is Patient Experience Measured?

The Centers for Medicare and Medicaid Services (CMS) use Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys to measure a patient’s experience with doctors, hospitals, health plans, and other healthcare entities such as home health agencies or skilled nursing facilities. In addition to CAHPS®, the Health Outcomes Survey (HOS) gathers patient experience data in Medicare Advantage programs.

Why does Patient Experience Matter?

Improving patient experience improves health. Patients who feel heard and experience positive care have better health outcomes and are more likely to adhere to treatment plans. CMS recognizes the importance of patient-centric care and have altered Medicare Advantage (MA) Star Rating calculations to emphasize patient voice as a critical input for the Star Rating System. The May 2020 Final Rule elevated the importance of 8 patient experience measures by doubling the weight from 2 to 4, meaning that patient experience and access measures will constitute 32% of a plan’s overall Star Rating in 2023.

Tips & Best Practices to Close Care Gaps in Quality Measure Programs

Patient Experience Measures

  • Identify PEX champion(s) in your organization
  • Establish and prioritize PEX goals
  • Consistently measure, monitor, and communicate PEX performance
  • Conduct service excellence training for new hires and on a routine basis for all personnel
  • Establish PEX workgroups to review data and quality improvement initiatives
  • Conduct PDSAs on lower performing measures
  • Use available resources from (CAHPS®) and HOS developers, quality reference guides, and tools from payors
  • Implement strategies that address patient experience during office visits with a focus on workflows

Patient experience must be a top priority for health plans and healthcare providers. At its core, value-based care is about helping the patient, aligning to their wants, needs, and preferences. Understanding the patient’s experience is a key step in moving towards patient-centric care.

References: CMS, AHRQ

About the Author

Tresa Shaw, MSN, RN

Tresa Shaw, MSN, RN

Director of Quality at CHESS