AMGA 2016: Linking Patient Experience to the Bottom Line

Patient experience experts from the Cleveland Clinic make the business case for meaningfully connecting with patients, also known as consumers.

How to give patients a better experience is no longer the mystery it was a decade or so ago. Hospitals and providers are more aware than ever that communication matters, that empathy matters, that even serving lasagna that patients actually want to eat can make all the difference in how a person feels about a hospital stay or medical encounter.

With expertise in ample supply, I returned from the American Medical Group Association's annual conference in Orlando with a notebook teeming with best practices.

But with competing priorities such as patient safety, quality, and other elements that visibly impact the bottom line, the 'why' for investing in strategies such as leadership rounding, communication training, behavioral interviewing, score transparency, and promoting a culture that makes those measures effective can still be a tough sell, according to a pair of conference speakers.

Lori Kondas, MBA, senior director for the office of patient experience at the Cleveland Clinic, and Joshua Miller, DO, FACP, medical director of the Cleveland Clinic Willoughby Hills Family Health Center and associate medical director of Cleveland Clinic regional operations referred to the urgency and importance of making these commitments as 'the burning platform.'

Why Patient Experience Matters
"Patient experience" as a buzzword dates back to the early millennium, when the Centers for Medicare & Medicaid Services began publicly publishing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for individual hospitals on its Hospital Compare website in 2008. In 2012, the stakes got even higher when a portion of hospital reimbursement became tied to HCAHPS performance.

While the penalties for sub-par performances have increased slowly, however, the dollars now are substantial. By 2017, HCAHPS scores will determine up to 2% of a hospital or health system's Medicare payments.

"The risk for not giving patients a good experience financially now becomes very high, so hospitals or practices that don't stand behind the fact that we need to take care of our patients both behaviorally and clinically stand to lose a significant amount of money," Kondas says.

What's more, there are several other ways patient experience indirectly, but cumulatively influences the bottom line, notes Miller. The industry's shift toward value-based care is only one.

"We'll sit down with our doctors and say, 'We really care about this.' We'll talk about narrow networks, how [payers] will drop physicians and things of that nature potentially on scores, so we need to start paying attention to it now or we're going to pay later because of it, either from a malpractice suit or other financial consequence," Miller says.

Meanwhile, the healthcare industry must also accept being in the midst of the age of consumerism, adds Kondas. "It really is patient experience overall that drives people toward where they choose. With that increasing amount of transparency that we talked about, patients can see what others think about you," she said.

"It's sort of like TripAdvisor. You can go anywhere and learn about a healthcare system—and not just about what the quality of care was, but how [consumers] were treated."

Cleveland Clinic's Turnaround
At the Clinic—a large, nonprofit, multispecialty academic health system made up of nine (soon to be 10) hospitals and conducting nearly 6 million patient visits per year—leaders started feeling the heat in 2008 when faced with HCAHPS scores well below the 50th percentile in several categories, particularly surrounding communication.

This wake-up call spurred the Cleveland Clinic to get serious about patient experience, leading not only to increases in system-wide training on communication and service, but also to the creation of the Clinic's first annual Patient Experience Empathy & Innovation Summit in 2010. Over the course of the past eight years of intense focus, the system's scores have steadily climbed.

Incidentally, I participated as a panelist in a discussion about healthcare social media at the 2011 Summit. Since then, the national event has truly taken off, Kondas told me after her presentation, now drawing more than 2,000 attendees—a roughly 10-fold increase since its inception.

The Challenge of Buy-in
Nonetheless, despite the growing interest in the topic, getting leadership buy-in to invest in patient experience—regarded by some as the "soft and fuzzy" side of medicine—is not a given, according to Kondas. "How do you help people who have an eye for the bottom line, an eye for resources, to really believe this is something worth focusing on?"

The predicament seemed to resonate with attendees. Based on a quick poll of the audience, made up of roughly equal parts physicians and administrators, about 75%, rated their organizations' cultural readiness to prioritize patient experience at a modest 5 out of 10.

Granted, it's not always leadership that needs to be sold on patient experience. Some reticence can be attributed to physician attitudes. In another informal poll of the room, Miller asked, "How many of you have physicians at your organizations who say, 'the scores aren't real'?"

"The scores are real," Miller said while looking out over the raised hands rippling through the room. "It's what the patient thinks and feels."

Miller went on to describe some of his own experiences with patient feedback and the importance of addressing comments and complaints. A patient who is angry about a long wait before an appointment, for example, is more likely to be distracted by that frustration and less engaged in talking over medical concerns with the provider, potentially snowballing into poor adherence, which may in turn contribute to a preventable hospitalization, to name just one plausible scenario.

Since 2011, Cleveland Clinic caregivers have learned how to handle these situations with a course in relationship-centered communication. "We tell the doctors it's almost like an MBA for communication," Miller says. "It's to give them more tools in their tool belt."

But these types of tools cannot be simply ordered from a supply catalog. They take time, commitment, resources, and follow-through to work effectively—a steep investment for which the returns can be tough to measure, at least immediately.

In the long run, however, caregivers who practice empathy are more efficient, according to Miller. Organizations engaged in patient experience, hiring not just for clinical skill but also behavior, see lower rates of costly turnover, notes Kondas. Patients who feel heard are less likely to sue, research has shown.

Ultimately, the business case boils down to this: "If you want patients to come to your hospital, you better make them happy," Kondas says.