Presentation of intravalley health for patient experience & satisfaction surveys

Center for Medicaid & Medicare Services (CMS) for
Rules of Communication but No Measurement for
Patient Understanding.

Intravalley Health
Patient Experience and Satisfaction Surveys
Modupe Sarratt

No Measurement
In today's healthcare, the patient expects a certain level of care when walking into a
healthcare facility and presumes a certain level of care and experience based on each or
every interaction patients have within that facility. In order to measure patient
experience and satisfaction, Intravalley Health must understand the dynamic of
healthcare regulations of medical care services for patient communication and provision
of care. Patient experience refers to the multidimensional set of factors that include
healthcare service and medical care, emergency care and hospital services, patient care
and nursing services, urgent care and ancillary services (e.g. Rite aid, Walmart, CVS
etc.), rehabilitative care and hospice care services. Many healthcare laws and
regulations govern the complexities of this dynamic.

Patient Satisfaction Measurement
To ensure compliance, Intravalley Health must adhere to Health Insurance Portability and
Accountability Act of 1996 (HIPAA) for procedures and the Affordable Care Acts (ACA) of 2010
for policies. These legal guidelines are in place to determine whether a patient has coverage, and
they set the administrative rules that apply to the Center for Medicaid/Medicare Service (CMS)
for deciding whether to treat a patient for render a care. To indicate that patient experience
encompassing the dimension of provider performance for policy and procedure are difficult to
measure for patient satisfaction. A journal article by Carrus, Cordina, Gretz, & Neher (2015)
implies that “patient satisfaction is likely to become an increasingly important source of
competitive advantage. Yet many providers cannot measure the patient experience
comprehensively” to show that there is more to learn about the patient experience.

There is no specific concept to define the patient experience as a measurement
of quality care. Due to the dynamic of healthcare services for medical
procedures, internal medicine is regulated by insurance policies, which
reimburse for provider performance. Provider performance is the “normative
and formative for the payment systems of quality care” (Berkowitz, 2016).
According to the departments and centers for general internal medicine (GIM),
the physicians who are board certified specialized in the care of adult patients
with various symptoms and medical issues with undefined symptoms for the
procedure performed by the providers.
Patient Experience Measurement

Intravalley Health is a healthcare
organization that strives to provide quality
care for their patients

Intravalley Health is a healthcare organization that strives to provide quality care for their
patients; they value their patient’s feedback to make improvements to their health services.
The organization strives to be customer-friendly, as their main concern is to provide the
correct and wanted services to their patients. Surveying and internal analysis of the patient
experience at Intravalley Health revealed that patient satisfaction is linked to medical
procedures and healthcare services. In order to improve the patient's experience, the staff at
Intravalley Health must understand the patient's experience for the cause of medical care and
the patient’s satisfaction is the effect of healthcare services.
Intravalley Health
The Patient Transaction for Satisfaction of Care
IH

Patient experience in the cause
(phenomenon) of medical care
IH
Provider performance is the “normative and formative for the payment systems of quality
care” (Berkowitz, 2016). According to the departments and centers for general internal medicine
(GIM), the physicians who are board certified specialized in the care of adult patients with
various symptoms and medical issues with undefined symptoms for the procedure performed by
the providers. Mayo Clinic.org (2018), the staff describes GIM procedures as follows:
Patients are seen in general for health examination as well as for consultation. The
procedure depends on the complexity of patient medical problems. Providers provide
preventive screening services for health maintenance, such as mammograms, Pap smears,
routine colon cancer screening, cholesterol screening, and blood pressure screening. For
the medical problem, providers provide comprehensive management of medical needs.

Patient experience in the cause of medical careIH
The GIM procedures are the type of health services rendered by Intravalley Health
providers that may include other services that cater to the needs of the elderly. For example,
elderly patients are more subjected to depressive symptoms for the complaint of chronic pain,
depression is a predisposition for indigestion, constipation, and diarrhea. As well depression can
be the cause of a chronic headache and stomachache, sleeplessness, and fatigue. 75% of
Intravalley patients are 50 years old plus, while the remaining 25% are between 30 to 50 years
old and generally only seen for routine checkups.

One of the problems observed affecting elderly patients is the lack of assistance with daily
activities. For that reason, Intravalley Health needs to extend care beyond written office policy
in order to bolster the patient’s experience of quality care. However, patient complaints stem
from limited access to care designed for post follow-up with doctors. Patients often never
follow-up, as they do not feel the need if no medical service is imperative and they feel fine. Per
policy, follow-up appointments are required within a 2-week period in order to refill any
medication; otherwise, another diagnosis must be performed. Patients are largely unaware of this
policy, feeling as though they are denied care for simply not abiding with provider
recommendations.

Patient Patricia Mellow allowed her experience to be used in order to help improve
Intravalley Health’s services. Mrs. Mellow, 68 years old, along with her husband, 82 years old,
took it upon herself to assist her husband in getting the care he needed, as his primary
caretaker. Due to differing schedules and conflicts, Mrs. Mellow could not accommodate the
follow-up date for both herself and her husband. The issue therein lies with follow-up
appointments being too regimented and not flexible enough to accommodate patients,
discouraging them from complying with procedural policies. Mrs. Mellow was not
comprehensively briefed on the enacted policy that follow-up procedures are required after
each initial treatment. Overall Mrs. Mellow had a negative experience in which she was denied
care due to misconstrued policy.

These are the types of scenarios that many patients can relate to for patient experience,
however, these are not the type of experience that can be measured by a survey for provider
performance; because patients internalize bad service for the poor quality care of medical
practices for dissatisfaction with health services. Patient expectations are not reflected in their
complaints and they feel that procedures and policies are inconsistent with the care that they
are receiving. Patient experience measured by using a survey developed by the Centers for
Medicare and Medicaid Services (CMS) to gauge clinical care setting is “inpatient service that
patients perceive for their hospital stay” (Carrus et al, 2015) to suggest that hospital patient
surveys are not for quality assurance of the provider performance for procedure, therefore, the
hospital patient survey cannot be used to measure a patient experience for patient satisfaction
in a clinical setting for a procedure (Appendix I, Patient Satisfaction Survey).

The cause of negative patient experience is from the strict regulations, policies, and
procedures of healthcare services in compliance with the Affordable Care Act (ACA) and all
HIPAA regulations. The Affordable Care Act's provision of healthcare service is through "a
series of requirements that sets forth health plans related to (1) designation of a primary care
provider, (2) coverage of emergency services, and (3) elimination of referral requirements for
obstetrical or gynecological care."(Office of Legislative, 2016) included in the medical
procedure for clinical evaluation with test and prescription to assure quality reporting of a
treatment and management of chronic diseases, and others services for evidence-based to
measure physician performance for quality of payment system to reimburse for health services.

Although the provision of care to Medicaid-eligible adults issued in 2010 include
the category for "Family Experience, this inclusion is not about the patient experience
of quality care" (Federal Register, 2010). Referring back to Mrs. Mellow's experience,
she was unhappy with having to retake a physical examination for a prescription
refill, due to missing a follow-up when she felt there was no cause for concern.
However, a healthcare provider or a doctor cannot base quality care solely on
patient’s expectations.

A provider’s quality performance is by abiding with the regulations of Health Insurance
Portability and Accountability Act (HIPAA) which requires the standards of procedures for
patient evaluation to report services rendered for quality (CMS for Medicare, 2015). What
patient care means to a patient for experience is able to get the treatment that helps to treat and
cure illnesses when is needed or the bits of help necessary to managed patient condition to make
improvement toward health. For the provision of ACA, managed care for a health plan is not by
a shared decision between provider and the patient for access to care and procedures. Although it
allows health promotion and education for patient’s resources and health status only to follow
regulations (Office of Legislative 2016) this shows that the outcome of patient care is provider
performance of procedure for healthcare coverage is the patient plan for health insurance.

The survey of 20 patients from Intravalley HealthIH
The survey of 20 patients from Intravalley Health suggest that patient experience of
dissatisfaction is with the provider performance for clinical evaluation that was indicated for
procedures. However, provider performance for the procedure is not for the patient treatment
that a patient measure for a quality care. Quality care is the regulated procedure that the
provider performed for a payment system or a provider performance for a procedure is a
quality care for the patient experience. However, the procedures are the experience for patient
dissatisfaction with provide performance. Therefore, the patient cannot truly measure
experience for quality care. Although patients can measure physician recommendation of
treatment or therapy that treat or cure patient illness to indicate patient satisfaction with care is
a treatment that works.

Patient satisfaction for the effect of servicesIH
Patient satisfaction is like a status report that describes things as they are or once were
for qualitative care. In this area, the differences between healthcare services and customer
services will be discussed. In retrospect to Mrs. Mellow her satisfaction lied with our
customer services, she asked which one of the services. She stated that Intravalley Health staff
upheld a friendly, professional environment, which she thoroughly appreciated. However, the
allied health workers are not the one making the decision for the type of care a patient
receives. Patient satisfaction, as an outcome of healthcare delivery, is an indicator of quality
care. Lack of thorough communication created an unpleasant experience that reflects poorly
on healthcare services.

Patient satisfaction for the effect of servicesIH
The patients have high expectations and with every healthcare experience, their
expectations increases. Our customers have choices on where to get their medical needs met.
They expect clinical competence but the service of a provider makes the difference.

Health Service for Patient SatisfactionIH
Health service is rated from patient’s interaction in which a patient has some leverage to
control the type of care that they are expecting. The notion is that a physician should be
available to render the care that a patient demands as part of the treatment. However, a
provider has to follow the protocols of clinical care. For example, a physician cannot just
write a prescription without a clinical evaluation. As in the case of Mrs. Mellow, a provider
cannot refill her prescription without a first-hand follow up on how the medication is working.
According to regulations, two weeks must be *allotted in order to review patient diagnosis
and effectiveness of treatment. As well allotted share of partial payment to the physician in
case the patient need a subsequent care or third party care.

Health service’s administration and insurance companies are also about the policies
of medical procedures, reimbursing providers for their services. Patients indicate a
satisfaction is the provision of treatments that work well to cure a disease and better with
managing a condition for a quality care. However, physicians indicate the performance of
regulated procedures for healthcare services are the quality of care for the patient
experience because the regulated procedures are the Affordable Care Act (ACA)
provisions that would improve the outcome of care to assure quality reporting of patient
care.

Quality reporting is the compilation of patient protection and affordable care act for
wellness and preventions program, health promotion activities, and services personalized to
improve and maintain patient health with risk assessments are the coordination of medical care
for the procedure. The medical procedure for a clinical patient evaluation is ongoing face-to-face
healthcare services. According to the ACA (2010), the compilation or accumulation of quality
reporting include such process for an effective case management of existing medical condition,
the care coordination of new service and management of chronic disease; and medication and
care compliance initiatives for treatment or services under the plan or coverage for healthcare
services (p.19, a & b). Healthcare service does not work in the same regard as customer service
when it comes to paying for medical care is physician’s performance of regulated procedures
implemented for healthcare services in the Medicaid Medicare program.

The Center for Medicaid Medicare Services (CMS) for healthcare provider initiative is a
shared savings program that meets the requirement specific to patient experience with a
different set of measures under ACA for Accountable Care Organizations (ACOs) to align with
the goal of providing the highest quality care to Medicare patients (CMS 2015), the Medicare
set of measures by ACOs is to capture patient experience for timely care, provider
communication, and provider rating.
Nevertheless, patients desire to have a good rapport with their providers to communicate
their preference for care can lead to patient satisfaction of medical care for customer
service. However, there is no clear distinction between patient satisfaction and patient
experience to measure quality care for a customer service, because the terminology varies
and are interchangeable with the factors and procedures used to measure clinical care.

Customer service in the physician’s perceptionIH
Customer service in the physician’s
perception is the patient expectation of care that
the physicians considered unrealistic with the
ACA provisions of care when compared to
policies and procedures by regulations are not
negotiable in order to appease patient
preference; the procedures are "doctor's
orders".

Although equal effort has been underway within healthcare
systems to address patient satisfaction for physician performance in the
delivery of medical care for quality care. The establishment of a
conceptual umbrella for the institution of quality, efficiency and
affordability of healthcare for a system that will pay for the provision of
healthcare based on the expectation of patient for quality care as one of
the precursors to health system reform for patient care involving the
metric system associated with improving care for a "Triple Aim".

According to Berwick, Nolan, and Whittington (2008), the Triple Aim developed by
Institute for Healthcare Improvement (IHI) is the pursuit of improving the experience of
care; improving the health of populations and reducing per capita cost of healthcare.
Berwick et al (2008) stressed the triple aims are interdependent without focusing on all
three at the same level to describe the goal include a focus on ethics, equity across
populations, and specific strategies to assure that the pursuit of one aim in isolation would
not adversely impact the other aims. To suggest the attempt is to measure the individual's
satisfaction with their care is the result of what individual experience on several levels.

Customer service in the physician’s perception
IH
Allied health workers such as nurses, medical assistants, and patient advocates are the
primary caregivers in all healthcare environments to promote patient care, which rallies to
good customer service. Although, over the years, clinical care response describes the concept
of patient experience and satisfaction. According to Berkowitz (2016), the regulatory “clinical
care response to the concept of patient satisfaction…often measure satisfaction score based on
the many factors that a patient experiences before, during, and after an episode of care, along
with characteristics of the care environment” contributes to the complexity of patient
satisfaction, which is linked to patient experience. The policy of general internal medicine
(GIM) is to evaluate patient experience. According to Mayo Clinic GIM (2018), the typical
GIM visit include evaluation processes that depend on the complexity of patient medical
issues (Appendix II: YouTube video).

Paper & Video
Double Click for LinkRunning head: INTRAVALLEY HEALTH 1
Intravalley Health: Patient Experience and Satisfaction Surveys
Modupe Sarratt
University of Maryland University College
HCAD 660-9041
Research Paper
March 25, 2018

A typical GIM evaluation at Mayo Clinic takes four to seven working days. The GIM care
team will coordinate appointments with the patient personal schedule as efficiently as possible.
Mayo Clinic summarizes GIM patient visit for experience as follows:
Based on the medical information, GIM may preschedule tests and appointments. Initial
GIM appointment GIM care team will conduct an evaluation, including a physical exam or
recommend appointments with specialists. After the initial appointment, GIM care team may
schedule additional tests and consultations with one or more specialists. GIM return
appointment after testing and specialty appointments are done, GIM provider will see patient
to review results. This may be the final visit with GIM provider or additional appointments
may be scheduled. GIM will then send a summary of the patient visit to the patient.

A patient experience for a health service is not the same with a patient experience for the
clinical procedure. Maple (2017) stated that patient experience tends to equate with the hospital
stay is Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAPHS).
HCAHPS survey was originally designed “to produce data about patients' perspectives to
enhance safety and accountability in health care… it does not measure the patient experience in
its entirety, however, ‘it does measure key aspects of care for pain management and the
responsiveness of hospital staff due to financial incentives associated with HCAHPS for
arranged value-based care’” (HTML page) is what tend to equate to quality care for patient
experience in the clinical care for a procedure. Therefore, HCAHPS is not the true measure of
patient experience of provider performance for a clinical procedure and doing so is a departure
from a practical approach to understanding patient experience for a care.

The fact shows there is more to learn about the patient experience for care
expectation of provider performance for clinical procedures. In clinical setting for medical
procedures, measuring true patient experience and care value is more complex because the
metrics must include provider performance, assessment of teamwork for patient
evaluation, communication of health services for promotions and options, connection of
services for healthcare coverage, caregivers, and families for related services pervade all
the aspects and the environments associated with patient experience for health service and
medical care.

Research has shown that patient experience is tied
to provider performance
IH
Research has shown that patient experience is
tied to provider performance for a medical
procedure, as well hospital service for patient
care, and others services for administrative
procedures combined to render quality of care
for the delivery of healthcare services, make it
difficult to know which parts or dimensions of
care for the patient experience. Patient
satisfaction is usually positive for treatment
that works to help the patient improve health
to dismiss patient experience for care is a
myth.

Research has shown that patient experience is tied
to provider performance
IH
Patient experience for a myth, Siegrist (2013) describe a survey of
patient experience is a contest “patients who fill out surveys are generally
unhappy with their care for a primary contest of a popular service and
quality of care are not related to patient satisfaction because patients
can’t evaluate the quality of care that is being delivered” to suggest that
a patient satisfaction may be the case in non-health care industries for
customer service because clinical care is a physician performance for a
patient experience.

Research has shown that patient experience is tied to provider
performanceIH
To the contrast of Medical Care Coordination for Managed Care
Service is the Patient Wait Time for Satisfaction or Dissatisfaction.
However, it is decidedly not true in medical care that requires wait
time for coordination of health service and clinical care such as, a clinical
evaluation of the patient for surgical operation cannot be a factor into
patient experience. As well patients expect the providers to be able to
coordinate their care for correlated services are the system of referral and
pharmaceutical for a prescription are wait time related to other medical
care or healthcare services.

performanceIH
Although the “2014 study in the American Journal of
Managed Care found that longer wait times correlated with
negative perceptions of care and lower levels of patient
satisfaction” (Weber, 2017, p.2). This is true, because, quality of
care is coordinated of medical and health services for the
provision of treatment by providers that comply with the
procedure for HIPPA regulation and the Affordable Care Acts.

performanceIH
Patient experience is difficult to measure for provider performance. The
option is to design a system of measuring patient satisfaction by assessing
treatments results and physician-patient interaction. Patients are usually satisfied if
the patients receive a treatment at the time that a treatment is needed as well if the
treatment works to improve patient health. Measure patient experience and
satisfaction can be accomplished by designating a patient-family advisory advocate
who focuses on patients’ needs for medical and healthcare service as well as the
patient family concerns about the impact of medical procedure.

The recommendation is having a Patient-Family Advisory
Advocate Board (P-FAAB)IH
The recommendation is having a Patient-Family Advisory Advocate Board (P-FAAB)
for cross-section decision making. The board should consist of ten (10) senior leader
members that include two (2) physicians that will be visiting patients prior to the
scheduled clinical procedures for a verbal briefing of writing procedure as prior instruction
for the expectation of provider performance for a procedure for a patient understanding.

The good best practice of a provider performance of a quality care is patient understanding
of a procedure for patient satisfaction.
Four (4) nurses to follow up after patient clinical procedure for an update on how the
patient feels about the procedure, and if the procedure help to relieve patient symptom for
good or bad, and to get patient review of the provider for performing a good job with
rendering of a quality care is patient care for a treatment.

Two (2) healthcare administrators that collect data from the patient in conjunction with
provider performance for the adjunct to a process of following the regulation that
compliance with policy for procedures. Two (2) allied health workers or social workers
that meets quarterly or every three months with patients and family who file complaints
about clinical care or service procedures to include them in decision making for
improvement.

This will allow for feedback on Intravalley Health’s overall services and future needs for
guidelines that include the followings:
1. a disclosure that a decision needs to be made
2. formulation of fairness of partners for a patient and provider interaction
3. presentation of care options for patient understanding and satisfaction with the choice
4. inform orally as well in writing the benefits and risks of the options,
5. investigate patient's understanding and expectations for identification of both parties
preferences for procedures
6. negotiation of reaching a shared decision by an arrangement of patient expectation for
provider performance and follow-ups

The Benefit of P-FAAB PrototypeIH
A prototype of guidelines for patient and
provider participation in decision-making to
measure patient expectation with physician
performance. As well to include new
innovation of patient experience for customer
service. Some researchers have proposed a
“Consumer Insights Survey” (Carrus et al.,
2015) as criteria for comparing the patient
experience to consumer survey that will not be
measured by clinical outcomes, but from
several sources associated with facility design,
staffs rapport, system of communications, and
the administrative correlated of services for
timely rendering of care to patient for a
satisfaction data .

P-FAAB PrototypeIH
*Source: Consumer Health Insight Survey,
2013 as cited in Carrus et al., 2015, p.6

ReferencesIH
ACA, A. C., & REPRESENTATIVES, U. H. O. (2010). Compilation of Patient Protection and Affordable Care
Act. Retrieved from
http://legcounsel.house.gov/Comps/Patient%20Protection%20And%20Affordable%20Care%20Act.pdf
Berkowitz, B. (2016, January 31). “The Patient Experience and Patient Satisfaction: Measurement of a
Complex Dynamic” Academic Library Journal of Issues in Nursing. Retrieved from
https://www.questia.com/library/journal/1P3-4097535131/the-patient-experience-and-patient-satisfaction-
measurement
Berwick, D., Nolan, T., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3),
759-769
Carrus, B., Cordina, J., Gretz, W., & Neher, K., (2015). Measuring the patient experience: Lesson from other
industries. Retrieved from https://healthcare.mckinsey.com/measuring-patient-experience-lessons-other-industries
CMS Center for Medicare. (2015). CAHP survey for accountable care organization Participating in Medicare
initiatives. Retrieved from http://acocahps.cims.gov/content/default.aspx

ReferencesIH
Congress, U. S. (2009). HR 3590: Patient Protection and Affordable Care Act. In 111th Congress (Vol.
2010). Retrieved from https://www.congress.gov/bill/111th-congress/house-bill/3590
Federal Register. (2010). Medicaid program: an Initial core set of health quality measure for Medicaid-
eligible adults. Retrieved from http://www.gpo.gov/fdsus/pkg/FR-2010-12
Maple, W. (2017, January 31). Going Beyond HCAHPS to Improve Patients' Experience. Retrieved
from https://www.hhnmag.com/articles/8011-going-beyond-hcahps-to-improve-the-patient-experience
Mayo Clinic.org. (2018). Services. Retrieved from https://www.mayoclinic.org/departments-
centers/general-internal-medicine/minnesota/services
Mayo Clinic GIM. (2018). Typical Visit. Retrieved from https://youtu.be/JaURTE14dMA MFMER,
Mayo Foundation for Medical Education and Research. Departments and Centers for General Internal
Medicine. Retrieved from https://www.mayoclinic.org/departments-centers/general-internal-
medicine/minnesota/services/typical-visit

ReferencesIH
Office of the Legislative Counsel, U.S. House of Representative. (2016). Compilation
of Patient Protection and Affordable Care Act. Retrieved from
http://housedocs.house.gov/energycomerce/ppacacon.pdf
Siegrist Jr, R. B. (2013). Patient satisfaction: history, myths, and misperceptions. Virtual
Mentor, 15(11), 982. Retrieved from http://journalofethics.ama-assn.org/2013/11/mhst1-
1311.html
Weber, S. (2017, Jan 9). Enhancing the patient experience with exceptional
customer service. Retrieved from www.physicianspractice.com/patient-
relations/enhancing-patient- experience-exceptional-customer-service/page/0/1

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Presentation of intravalley health for patient experience & satisfaction surveys