CG-CAHPS and the Physician Revenue Cycle

Survey ToolThe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is a standardized survey tool to measure patient perceptions of care delivered by a provider (e.g. physician, nurse practitioner, physician assistant, etc.) in an office setting.

The Centers for Medicare & Medicaid Services (CMS) issued the final rule in November 2012 confirming implementation of CG-CAHPS for Physician Quality Reporting System (PQRS) participants as part of the CAHPS for PQRS program. CMS requires CGCAHPS data collection for medical practices with over 100 eligible professionals under one tax identification number who are submitting PQRS through the GPRO web interface and will start voluntary participation for groups with at least 25 eligible professionals in 2015. Both Pioneer ACOs and Medicare Shared Savings Program ACOs are required to participate in annual CG-CAHPS data collection as part of the ACO CAHPS program.

The CG-CAHPS tool is one of a series of patient experience survey tools developed by the Agency for Healthcare Research and Quality (AHRQ) that are in use by health plans, hospitals, and home health agencies to understand their patients’ perceptions of their quality of health care.  CG-CAHPS is the survey tool developed to assess a patient's satisfaction with the doctors and other practitioners providing care in an outpatient setting.

For medical practices with more than 100 providers under one tax identification number and participating in Physician Quality Reporting System through the GPRO web-interface reporting will impact their value modifier (VM) payment in 2016. The 2014 proposed rule states that PQRS CG-CAHPS participation would be voluntary for groups over 25 providers and could be selected as one of the areas calculating VM for practices over 100, regardless of how they submit PQRS data.

Also, the CG-CAHPS instrument has been selected for evaluating the patient experience as part of both the Pioneer Accountable Care Organization (ACO) program and the Medicare Shared Savings Plan ACO program.  There are state and regional initiatives that use variations of the publicly available CG-CAHPS instrument.

Patient satisfaction data - along with quality data - is likely to increasingly become a part of reimbursement formulas for physicians.  Health care reform legislation passed by Congress created a “Physician Compare” web site, which went live Jan. 1, 2011. Physician Compare is comparable to other CMS websites that report quality data on hospitals and home care agencies and will include clinical measures already collected through the Physician Quality Reporting System (PQRS) in 2013. The legislation also requires patient ratings be considered for inclusion on the web site. For Pioneer and MSSP ACOs, 25% of their quality results will be based on CG-CAHPS and ultimately impact their ability to share in savings. For medical practices impacted by CG-CAHPS, at least 16.7% of value-based dollars will be based on CG-CAHPS as part of the value modifier (VM).  For these group's, the final quality score which represents the average standard deviations from the national average will be used to place them into a category of high quality, average quality, or low quality.

In the hospital program developed by Medicare (Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS) participation was initially voluntary but soon hospitals not reporting the data were penalized 2% of their Medicare collections.  Physicians should assume that the same will be the case for them.

There are also other reasons for a physician practice to implement a patient satisfaction survey.  Soliciting feedback from your patients can improve a practice in many ways, such as helping a group to prioritize service initiatives, recognize outstanding staff members and increase referrals. With the move toward value-based purchasing and tougher competition, now is the time to make sure that your organization is focused on the importance of patient satisfaction.