In an Aug. 4 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., made it clear that the Academy continues to support "reasonable and achievable programs that promote continuous quality improvement and that measure patient experiences."
However, Wergin said survey results that reflect a patient's level of satisfaction with health care experiences should be used only to incentivize physicians and practices, not to impose financial penalties.
"We feel that the lack of maturity in patient satisfaction resources supports our position, and we believe CMS should not establish financial penalties for factors outside of a physician's control." That includes the lack of patient engagement when it comes to completing a survey about an encounter with a physician or a practice, said Wergin.
Furthermore, "Only statistically and reliably valid data should be used in value-based payment programs and publicly reported," he added. Specifically, measures must be
- clinically relevant,
- aligned among all public and private payers, and
- minimally burdensome to report.
The AAFP suggested CMS take advantage of work done by the Core Quality Measures Collaborative -- a multistakeholder group in which the Academy is an active participant -- and utilize the core measures sets already developed by that group.
And as always, the Academy continues to support family physicians working in small practice settings; in this instance, the AAFP urged CMS to keep implementation costs related to patient experience measures at a level those practices could afford.
Specifically, Wergin recommended that the use of an existing program dubbed the Consumer Assessment of Healthcare Providers and Systems be optional for practices of all sizes until that program or something similar is available to physicians at no cost.
Also, in an effort to encourage CMS to rein in the burgeoning administrative burden physicians struggle with daily, Wergin called on the agency to allow free online access to surveys -- a move that could also encourage patient participation.
Finally, the AAFP addressed physicians' unease with the possibility that patient satisfaction scores would be tied to opioid prescribing.
Wergin pointed to questions related to pain management that appear on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and he noted that those hospital scores were then tied to Medicare payment.
"To mitigate the perception that there is financial pressure to overprescribe opioids," the AAFP fully supports the proposal to remove the HCAHPS survey questions on pain management from the hospital payment scoring calculation, said Wergin.
Hospitals should continue to use the questions to assess patients' level of satisfaction with their inpatient pain management experiences, but those answers should not be tied to payment.
Ultimately, a similar policy should be extended to all patient experience measures, Wergin concluded.
Related AAFP News Coverage
Delegates Address Patient Satisfaction as Quality Metric, Other Issues
More From AAFP
The Core Quality Measures Collaborative
CMS: Core Quality Measures Collaborative Release(www.cms.gov)