With the 2023 performance year quickly approaching, home health agencies need to understand the Quality Outcome Measures used for Value-Based Purchasing (VBP) Calculations.

The Home Health Consumer Assessment of Healthcare Providers and Systems’, or HHCAHPS, portion make up 30% of the VBP score. All other components are data driven. The HHCAHPS Survey element is all about patient perception, which is not always fact driven.

When it comes to encounters with others, whether as a patient or daily human interactions, Maya Angelou said it best.

Patient perception stems directly from how they feel and what they take away from visits. So, how can home health agencies put their best foot forward with patient satisfaction? Here is one survey question you may see regularly:

“Willingness to recommend the agency to friends and family.”  Respondents can select from:

  • Definitely yes
  • Probably yes
  • Probably no
  • Definitely no

In order to set the stage for a positive response from the patient, this involves connecting with them beyond the clinical encounter. Let’s take a look at a scenario:

Nurse Nancy has a busy schedule.  She contacts her patients the afternoon before planning her route so that her last visit is closest to her home because she feels this is the most efficient way to schedule.  Due to many nurses being on vacation, she is taking on extra patients to help the team. Nurse Nancy is very intelligent, knowledgeable and she is structured in how she provides teaching to her patients.

Let’s analyze Nurse Nancy and see what is going right and what could be improved to further patient satisfaction.

On one hand, Nurse Nancy presents herself in a professional manner and is confident about herself and her expertise.  Despite seeing more patients than normal, she remains prompt and is providing a two-hour window for when patients can expect her to arrive.  She is efficient with how she spends her time in the home and only sits when she is making notes on her tablet.  The patients tend to not ask Nurse Nancy many questions, so she feels that her communication is clear and easily understood. This sounds great in theory, but let’s take a deeper look into how Nurse Nancy operates her visits.

One of her patients, Mr. Jones, has stated he would not choose Nurse Nancy the next time he needs home health care.  While she is always on time, arriving within the window she provides him the night before, he wishes her visits were a little later in the day.  While she always has a professional and confident appearance which does instill respect for her knowledge, she is always in a rush. Nurse Nancy talks a majority of the visit and only pauses for brief eye contact and a smile.  Mr. Jones finds that due to the environment of the visit described, he often finds himself hesitating to ask questions when she uses clinical terms unfamiliar to him or when he needs clarity.

In this scenario, it is clear the patient does not feel valued as a person due to Nurse Nancy trying to get through her day as quickly as possible. Not only is the appointment time slot not ideal, but the patient is intimidated by the terminology presented and feels as though there is not enough time for clarification.  Overall, the patient feels as though visits are not efficient and the necessary care is not being delivered.

How does this affect a home health agency at large? Let’s revisit the original survey question: “Willingness to recommend the agency to friends and family.” When a patient feels unvalued and has strong opinions, there’s a higher chance they will complete the HHCAHPS survey. Although Nurse Nancy believes her visits with Mr. Jones have been successful in improving his clinical condition, the survey will tell a different story.

Clinicians must be sensitive to a patient’s perception and how they interpret visits through actions and words. Let’s look at three small steps that can be made day-to-day during patient interactions to improve patient satisfaction:

  • Sit down, relax, and make eye contact – It is important to always be aware of what your non-verbal language may be communicating to your patients. Your body language impacts patient care including factors such as time spent interacting with the patient, body posture, and proximity to the patient. Eye contact is one of the strongest ways to create a connection with a patient and a comfortable environment. Clinicians should examine how they are presenting themselves to a patient.
  • Ask the patient about their preferences – In order to honor patient preferences, you should be inquisitive about what works best for the patients schedule and if that can’t be accommodated provide thorough explanations. Patients want flexibility and convenience so attempts to ask patients desired appointment times and providing an explanation of how scheduling works is necessary.
  • Avoid medical jargon – When staff use words that are unfamiliar to patients, this can create an overwhelmed feeling and confusion as they navigate their healthcare. The use of plain language when discussing medical terms is preferable and goes a long way to making a patient feel more comfortable. Another approach clinicians can take is asking the patient how they themselves would explain a clinical teaching to a family member or friend, to confirm they understand.

While the HHCAHPS survey makes up 30% of an agency’s VBP score, it also provides valuable and meaningful feedback. The publicity surrounding the survey results holds providers accountable and creates incentive to deliver top quality care to patients. There are numerous ways your organization can work to implement a one-to-one connection with patients and provide a safe, comfortable environment.

Do you know where your organization stands when it comes to HHCAHPS measures and results? Reach out to McBee today to determine whether the HHCAHPS measures and patient satisfaction should be a top focus area for your organization to prepare for the first performance year of Home Health Value-Based Purchasing.  McBee takes a meaningful approach to implement effective and actionable value-based purchasing strategies throughout your organization. To achieve best clinical and financial outcomes, we optimize OASIS and coding processes, as well as measure against STAR and HHCAHPS ratings. Learn more today.


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