How Patient Experience Affects Healthcare Quality and Reimbursement

Hotels feature walls made of succulents and greet travelers with warm chocolate chip cookies on arrival. The elevator at the building downtown pipes in calming nature sounds. Movie theaters feel like plush living rooms. Now, the enhanced experiences consumers expect and receive elsewhere are coming to healthcare facilities. But more importantly, your organization’s quality scores and reimbursement levels increasingly depend on the ability to deliver an overall positive patient experience through improvements like hospitality and ambiance. 

What’s the difference between patient satisfaction and patient experience?

The terms patient satisfaction and patient experience might be used interchangeably, but they aren’t the same thing. While both are integral components of healthcare quality, they aim to gather different information for different uses.  

Striving for patient satisfaction in healthcare isn’t a new concept. Press Ganey, founded in 1985, began one of the earliest efforts to survey and track patient satisfaction for widespread comparison among organizations. In 2006, CMS implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), today’s standard survey and data collection method to measure patients' perspectives of hospital care. The Agency for Healthcare Quality & Research (AHRQ) writes that measuring satisfaction is about determining whether a patient’s expectations about a health encounter were met. To gauge satisfaction, the healthcare organization asks its questions of patients, to find out what it wants or needs to know.

Patient experience, on the other hand, flips the lens and puts patients at the center of the inquiry. Gauging experience requires measuring the range of interactions that patients have with multiple touch points of the healthcare system. That might include care from health plans, practitioners and other staff in hospitals, physician practices, and other healthcare facilities. Patient experience measurement goes to the heart of seeking data on the things patients value highly—such as getting timely appointments, easy access to information, and good communication with practitioners. It includes measurement of patients’ feelings, emotions, and needs.

Understanding patient experience is a key step in moving toward patient-centered care and population health management. By looking at various aspects of patient experience, organizations can assess the extent to which patients are receiving care that is respectful of and responsive to individual their preferences, needs, and values. Evaluating patient experience along with other components such as effectiveness and safety of care is essential to providing a complete picture of healthcare quality.

Patient experience is: 

  • The sum of all interactions the patient has with the healthcare organization.
  • The orchestrated touch points of people, processes, policies, communications, actions, and environment, shaped by the organization’s culture.
  • The vision, values, people (at all levels and in all parts of the organization), and community that influence the patient’s perception. 
  • What is recognized, understood, and remembered by patients and their supporters (family, friends). Perceptions vary based on individual experiences such as beliefs, values, cultural background, etc., across the continuum of care before, during, and after the delivery of care (i.e., to outcome).
  • Associated with lower medical malpractice risk and greater employee satisfaction.
  • A sound predictor of patient loyalty.

Patient experience as a recurring theme in value-based models, affecting hospital reimbursement

Increasingly, your organization will be paid and rewarded with risk pool incentives and through shared risk models that consider patient-reported experience. The weight that patient experience carries in the distribution of payments varies, but the takeaway is that improving overall patient experience is associated with good processes and outcomes—and it makes good business sense. 

Patient experience measurement programs affect health plans and payers:

  • CMS’s HCAHPS for Medicare beneficiaries are tallied along with CMS’ Star Rating Program for quality measurement.
  • HCAHPS is required for accreditation by the National Committee for Quality Assurance (NCQA).
  • More states are requiring Medicaid HCAHPS for Medicaid and Children's Health Insurance Program (CHIP) enrollees.
  • Health plans participating in federal health insurance marketplaces must conduct a version of HCAHPS, which rolls up into CMS star ratings.

For healthcare organizations, patient experience measures are a part of the following programs:

  • The Affordable Care Act of 2010 includes several provisions for measuring and reporting patient experience of care.
  • The NCQA’s Patient-Centered Medical Home program includes optional recognition of patient experience.
  • The American Board of Medical Specialties (ABMS) is exploring the possibility of requiring medical boards to use patient experience measures when awarding physician maintenance of board certification.
  • Select health plans are adding patient experience scores into provider pay-for-performance incentives with value-based care and reimbursement. New measures are now included for this and must be tracked.

Who should be involved in patient experience initiatives?

While practitioners who deliver care and services occupy patient-facing roles, the circle of individuals who participate in patient experience is much wider. Executives and medical staff leaders are often aware of the weight that their words and actions carry in striving for positive patient experience. But support staff and others might not be aware of the extent of their influence on a patient’s experience. As a result, education and training at all levels is warranted. 

Your organization may need to create a new role responsible for the strategic development, planning, and oversight of the patient care experience function and related programs, strategies, initiatives, policies and procedures. 

Best practices for achieving high patient experience scores

Symplr ‘s quality professionals believe that healthcare organizations committed to providing the best in patient experience will undertake a multi-pronged approach, including:

  • Identify and support accountable leadership with committed time and focused intent to shape, guide, and execute experience strategy.
  • Develop a formal definition for what experience is/means to your organization.
  • Establish and reinforce a strong, vibrant, and positive organizational culture. Enabling transparency and/or implementing a Just Cause initiative is vital. Trust and openness matter.
  • Implement a defined process for continuous patient and family engagement, as well as community partnership.
  • Engage the voices of staff, clinicians, and healthcare professionals to drive comprehensive and lasting solutions. Employee and provider satisfaction and work experience are major factors in a patient’s experience.
  • Ensure an active commitment to both health equity and access to care.
  • Expand focus on health outcomes beyond treating illness, to promote overall health, wellness, and well-being.
  • Acknowledge that the healthcare experience reaches beyond clinical interactions to all touchpoints across the continuum of care.
  • View everything from the patient’s perspective. It is your job to change their perception.
  • Use HCAHPS, star, and other survey and scoring methods—but be sure to provide innovative ways to address and track improvements internally as well to document improvements. 

To truly strive for patient-centered care, the ultimate goal of patient experience, involve every person in your organization and create forums for ideas and suggestions. What can you do today to plan for a better patient experience? 

Contact symplr’s quality professionals today for more information!

Learn more


Request a Demo