Patient Satisfaction Key for Payer Measurement of ACO Quality

March 17, 2017 - An article from the American Journal of Managed Care reveals that patient satisfaction within an accountable care organization (ACO) is a strong indicator of the care quality level the organization delivers, giving payers an opportunity to use the metric as a way to guide future development.

A research team of three doctors from the Boston Veteran Affairs Hospital (VHA) used administrative data on wait times for patients in the VHA during 2012 to measure patient satisfaction and see what points of interaction impacted those rates.

By measuring satisfaction rates, payers are able to determine if providers are properly addressing care concerns and meeting quality standards for reimbursement. Improving every quality metric within an ACO increases care utilization and revenues, while decreasing high healthcare costs such as hospital readmissions.

They found that 80 percent of respondents reported higher satisfaction rates with short wait times and quicker appointment scheduling. The findings also reveal that improvements in administrative functions and technology are critical for maintaining satisfactory care and quality standards within ACOs.

About 58 percent of patients rated their entire VHA care experience over 12 months as either a “9” or  a“10” on a scale from 1 to 10, with 10 being the most satisfied. Of the respondents, 82 percent said it was “always or usually” easy to receive care.

Notably, 79 percent of respondents found it “always or usually” easy to get an appointment with a specialist, and another 81 percent rated their most recent visit as a “6” or “7” on a scale of 1 to 7.

These satisfaction rates increased as the time to schedule and complete a care action decreased.

The highest levels of patient satisfaction occurred when it took between 23 and 27 days to complete a care action. Those patients reported extremely high satisfaction in timeliness of visit (85 percent), facility rating (95 percent), treatment access (88 percent), specialist access (89 percent), and overall satisfaction with the VHA (90 percent).

Comparatively, patients who waited more than 33 days for treatment experienced much lower satisfaction in all categories. A significant drop in satisfaction was seen in timeliness of visits (76 percent), facility rating (86 percent), treatment access (80 percent), and specialist access (79 percent).

While ACO measures such as wait times impacted patient satisfaction, the study showed that the time it took the VHA to complete a first action, such as scheduling initial consulting appointments or printing a document, did not majorly affect patient satisfaction.

The researchers found that it rarely took more than a couple of hours to complete these first actions, and satisfaction rates never dipped lower than 90 percent on first action wait times.

Even though the ACO performed well overall, there were disparities in satisfaction because patients could not control the time it takes to schedule and administer care. The researchers suggested that new tools and electronic systems can alleviate these concerns.

“Because patients often report high levels of powerlessness and uncertainty while waiting for consultation, these wait times are an important patient-centered access metric for ACOs to consider,” the researchers said. “ACOs should have systems and tools in place to streamline the specialist consult referral process and increase care coordination.”

Wait times have been a problem for several VA facilities in the past few years, and continue to be problematic under the Veteran’s Choice Program. But these findings from the Boston VHA show that specialized facilities have the potential to offer quality care to veteran populations.

“The findings from this study also expand our understanding of administrative access metrics that are patient-centered,” the team concluded. “In contrast to the measures, days to scheduled consult and days to completed consult, the days to first action measure had no relationship with patient satisfaction.”

“As ACOs and the VHA put a greater emphasis on the experiences of patients, these findings suggest that metrics should focus on measuring tangible processes that patients easily understand as action being taken on their behalf, such as scheduling appointments.”

The team concluded that the consult times are an anxiety-inducing part of the patient experience, and can be obtained and analyzed from the scheduling system. ACOs that need to improve patient satisfaction can use these times to better manage consultation length with the end goal of improving an ACO’s overall quality.