“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “One More Thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has “one more thing” to discuss. You think to yourself, No! I almost made it out of the room on time! You now have a decision to make. Do you tell your patient he is out of time and will have to wait until your next visit? Do you sit down again knowing you are already running late? It feels like a no win situation. If you end the visit without acknowledging the additional concern, your patient will be upset. If you run too late, your next patient will be frustrated by the wait. You begin to wonder if it is truly possible to maintain a good patient experience despite a schedule filled with patients suffering from the “one more thing” syndrome. Absolutely!

We all know the patient experience is a hot topic within healthcare for both inpatient and outpatient providers. Like me, you’ve probably been asked by your employer to create definitive ways to improve your patients’ experience. What can you do? The following tips show you things you can do RIGHT NOW, so the next time your patient says, Doc, can I ask you one more thing?, you can definitively say, Yes.

Tips to maintaining a great patient experience even when patients have
“one more thing” to discuss.

1.    Be proactive

One way to discourage patients from saving important topics until the end is to ask them what they want to discuss before the visit begins. There are several ways to do this. You can ask your nurse or medical assistant to gather this information for you when they register or room the patient. You can ask your staff to give all patients a Patient Agenda Form. This form asks patients to prioritize and record exactly what they want to discuss during the visit. It can be downloaded for free here: www.drtrinadorrah.com. Finally, most patients have a smartphone, so encourage them to use it to keep track of their questions and concerns.

2.    Stand

Throughout our training, we are taught that sitting increases our patients’ perception of time spent with them. I completely agree. However, when trying to combat the “one more thing” syndrome, I advocate for standing. The reality is that doctors simply do not have time to spend another 15-30 minutes in the room. Unless it truly requires extended time, I recommend you address your patient’s additional concern while standing. Your patient is still happy that you addressed their concern, but standing acts as a visual reminder that the visit is over.

3.    Address at least one additional concern

If your patient has several additional concerns, you will have to use your medical judgment to prioritize. Explain why you chose that particular concern as the priority so your patient understands your rationale. Other times, your patient only has one additional complaint, but the differential is huge. Take ‘fatigue’ as an example. Multiple things cause fatigue, but you can quickly order a couple of tests to begin the workup. Ordering a CBC or TSH only takes an extra minute, but your patient will feel like you cared.

4.    Follow the leader

     Signal to your patients that the visit is over by inviting them to follow you out of the room. Offer to walk them to the lab or checkout desk. If your nurse needs to enter the room after you, let your patient know that you need to find your nurse to proceed to the next step of their visit. These strategies still allow you to leave the room, but it sends a message to the patient that you care about them and are still working on their behalf even after you step out.

Dr. Trina Dorrah is an internal medicine physician/hospitalist who is passionate about helping providers improve their patients' experience. She is the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS.

Get Ready for CG-CAHPS

by Trina E. Dorrah, MD, MPH

I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient experience. Lately, I’ve spent a lot of time discussing a patient experience survey known as CGCAHPS (Clinician & Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CGCAHPS is a topic that produces little excitement. In fact, if you ever want to end a party early, start talking about the patient experience. I understand, but like I tell my coworkers, focusing on the patient experience is here to stay. So if you can give me a couple minutes of your time, I’ll explain why this is so important, and give you 3 things you can do today to begin improving your patients' experience.

  

What is CGCAHPS?

CGCAHPS is a standardized outpatient survey that various organizations, including Medicare, are using to assess your patients’ experience with the clinic visit. In case you’re wondering, the terms patient satisfaction and patient experience are often used interchangeably. In reality, they are actually  different. For example, if you diagnose Mr. Thomas with diabetes, he won’t be happy, but he can still be satisfied with the overall clinic experience. The CGCAHPS survey tries to differentiate the care experience from the patient’s emotions. This is helpful because it’s easier to improve an experience. 

There are seven questions on the CGCAHPS survey that specifically relate to you, the provider. When your patients complete the survey, they are asked to rate you in these seven categories.

1.     Did this provider explain things in a way that was easy to understand?

2.     Did this provider listen carefully to you?

3.     Did this provider give you easy-to-understand information about these health questions or concerns?

4.     Did this provider seem to know the important information about your medical history?

5.     Did this provider show respect for what you had to say?

6.     Did this provider spend enough time with you?

7.     Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?

When the scores are reported, you only get credit for the most favorable response. For example, if the survey gives your patients three choices (yes, definitely; yes, somewhat; no), you only get credit for the number of patients who choose the highest score (yes, definitely).

Why should you care?

As physicians, we all want to improve the care we provide our patients. This is what we do every day, so we don’t need a survey to make us do the right thing. However, the Affordable Care Act has increased the stakes by requiring physicians to use the CGCAHPS survey to assess the patient experience. The eventual goal is that all providers who participate in fee-for-service Medicare will measure their patients’ experience with the CGCAHPS survey. This information will be publicly available on the Physician Compare website. Once the survey is implemented, the next step will be to link the survey responses to reimbursement through the Physician Value-Based Payment Modifier. The Physician Value-Based Payment Modifier is a way for Medicare to tie pay to performance. Doctors who perform well on certain quality and cost metrics, including the patient experience, will be paid more than those doctors who do not. How will the patient experience be measured in this program? You guessed it…through CGCAHPS.

So we’ve come full circle. Create a standardized patient experience survey (CGCAHPS), require its use (through legislative reform), link reimbursement to the patient experience (via the Physician Value-Based Payment Modifier), then differentiate between providers based on the patient experience through a standardized survey (CGCAHPS).

What can you do to prepare?

Begin working to improve your patients' experience now. For starters, follow the 3 tips listed below. The first phase of the Physician Value-Based Payment Modifier begins in 2015. You do not want to be caught unprepared.  

1.    Learn as much as you can about the CGCAHPS survey.

·     There are several books, articles, and websites about CGCAHPS. Pick one and begin learning all you can.

2.    Incorporate patient experience improvement tips into your daily practice.

·     Find a book, article, or website that gives suggestions for improving the patient experience. Choose a few helpful tips, and immediately incorporate them in your practice.

3.    Involve your entire clinic staff in your improvement efforts.

·     Educate your staff on the CGCAHPS survey and challenge them to find ways to improve your clinic’s scores. Improvement is a joint effort, and involving your staff will ultimately improve your scores, too.

Trina E. Dorrah is an internal medicine physician/hospitalist and author of Physician's Guide to Surviving CGCAHPS & HCAHPS.