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CONTENTSExecutive Summary

Vendors Covered in This Report

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5

Demographics 6

Benchmarks

Conclusion

Appendix

Size BenchmarksBy VendorBy TitleBy Bed Count

Price BenchmarksBy VendorBy TitleBy Bed Count

Reporting BenchmarksBy VendorBy TitleBy Bed Count

Customer Service BenchmarksBy VendorBy TitleBy Bed Count

Survey BenchmarksBy VendorBy TitleBy Bed Count

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30

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Vendors Used Among Participants 8

Provider Recommendation Scores 10

EXECUTIVE SUMMARYSometimes you need a “meta” approach to technology. This report goes deep into research regarding HCAHPS vendor solutions. It is the Voice of the Customer or Hospital Voice of the Customer customers. Don’t let the irony bother you. Nothing needs better oversight than the tools used to gain information. That is what we aim to do with this report.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the first national, standardized, publicly reported survey of hospital patients. The Centers for Medicare and Medicaid Services (CMS) suggests HCAHPS has three broad goals:1

• Produce data about patients’ perspectives that create objective comparisons of hospitals.• Create new incentives for hospitals to improve quality of care through public reporting.• Enhance accountability in health care by increasing transparency of the quality of hospital care.

In addition to these market forces that are an attempt to empower consumers,2 CMS uses HCAHPS scores to alter reimbursement rates to hospitals.3 This means that an average hospital stands to gain or lose millions of dollars based upon the result of HCAHPS each year.4

Any survey researcher will tell you that methodology matters and can impact results. Hospitals literally have millions of reasons to pick an HCAHPS vendor that will receive the best results. For that reason, we offer this report regarding perceptions of the HCAHPS market according to 369 hospital leaders.

Clearly, the market for HCAHPS vendors has a dominant player in Press Ganey, but there are many opportunities for other vendors as well. This report documents the features of HCAHPS vendors that customers look for, and their satisfaction levels with their vendors.

This report also gives a great guide to the various features and differentiators of the HCAHPS market. It covers:

• Size of survey sample• Price of service• Reporting functionality / analytics• Customer service• Other proprietary surveys

The answers are here for your consideration.

Report Author: Tyler Page

1 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/HospitalQualityInits/Hospital HCAHPS.html2 http://histalk2.com/2014/03/10/histalk-interviews-regina-holliday-patient-advocate/3 http://www.healthleadersmedia.com/finance/better-hcahps-scores-protect-revenue4 http://www.healthcarebusinesstech.com/patient-satisfaction/

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VENDORS COVERED IN THIS REPORT

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DEMOGRAPHICSA survey is only as good as its participants and thanks to our respondents, we believe this is the most comprehensive industry report on the HCAHPS market to date. Unlike “research firms,” we do not hide information about our survey respondents. We want you to know that the data you’re reading is good and that it came from people in a position to give intelligent feedback.

This research was based on responses from 369 different people. Respondents were not just folks picked off the street. Rather, they are hospital leaders with power to make or influence purchasing decisions. Don’t believe us? Here are their job titles.

CNO

Quality Director

Director of Patient Care

Director of Patient Access

Clinical Director

Other*

PARTICIPANTS BY TITLE

*Other: Manager of Patient Accounts; Director of Emergency Services; Director, Patient Financial Services; HIPAA Security; Clinical Informaticist; Marketing Manager & Patient Advocate; Director of Administrarive Services; Manager Med Surg and ED; Patient Accounts Manager; Accounting Clerk; Director of ProviderDevelopment; Director of Regulatory and Compliance; Director Medical Staff Relations; Hospital Administrator; Patient Advocate; CEO; Imaging Manager; RN; Chief Operations Officer; Office & Billing Manager for Home Careand Hospice; Nurse Practitioner; Radiology / Patient Navigation; Accounts Payable Specialist

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This may surprise some companies out there, but many healthcare IT solutions are not “one size fits all.” Rather, hospitals of different sizes often have different technology needs. Therefore, we try to get a broadsampling and break down results by bed count.

DEMOGRAPHICS CONT.

PARTICIPANTS BY BED COUNT

0-25 Beds

26-100 Beds

101-250 Beds

251-500 Beds

501+ Beds

Ambulatory

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WHICH OF THE FOLLOWING VENDORS DO YOU USE TO MEASURE HCAHPS SCORES?

We set out to get an accurate look at the market for HCAHPS. The following is a breakdown of the current providers serving our respondents. It is no surprise that Press Ganey is the largest player in the market. However, there is always a bigger fish in the pond as we’ve seen with their acquisi-tion news by EQT. It will be interesting to see how this affects their business for good or ill. Re-gardless, there are opportunities with other players rising up to compete for the space.

Press Ganey’s dominance changes somewhat, but not wildly, depending upon the number of beds in a hospital. In contrast, some of the smaller competitors have clear niches they tend to work with. More interesting, Press Ganey does not have the same level of dominance among ambulatory organizations, with the gap between this vendor, HealthStream and NRC Picker much narrower than acute care facilities. We can only take a stab as to why this is but since 900lb gorillas can often charge 900lb prices, perhaps smaller ambulatory organizations more often opt for a more economic approach.

VENDORS USED AMONG PARTICIPANTS

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0-25 Beds

26-100 Beds

101-250 Beds

251-500 Beds

501+ Beds

Ambulatory

VENDORS BY BED COUNT

VENDORS USED AMONG PARTICIPANTS CONT.

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PROVIDER RECCOMENDATION SCORES

5 F = 4.5, p = .001, All statistical significant tests used the .05 level6 p = .0077 p = .006

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AVERAGE VENDOR RATING

A one-way ANOVA confirmed there was a statistically significant differences in rating depending upon the vendor used.5 Tukey’s post-hoc test confirmed there was a higher recommendation rating for Press Ganey over both HealthStream6 and Avatar7 .

We asked each customer how likely they are to recommend their HCAHPS vendor to someone else. The results tell a whole lot about the state of the HCAHPS market and the comparative quality of the different solutions out there. How satisfied are current customers? This report explains the answer to that question, and it gives you a good idea about the trends of the market.

Large general numbers can only take you so far. There are niche markets and people with differing perspectives based upon a variety of factors. For example: Who said what exactly? Is there a disparity in recommendation based upon the job title of the person responding? How do the numbers of beds in hospitals impact attitudes toward individual vendors? These little charts tell you about the comparative levels of satisfaction by job title and hospital bed count.

PROVIDER SCORES CONT.

PREMIUM CONTENT AVAILABLE TO STUDY PARTICIPANTS AND LICENSED REACTIONDATA

CLIENTS.

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A one-way ANOVA confirmed there was a statistically significant differences in rating depending upon the vendor used.5 Tukey’s post-hoc test confirmed there was a higher recommendation rating for Press Ganey over both HealthStream6 and Avatar7.

Ambulatory facilities viewed their vendor less favorably than other facilities, with a fairly large discrepancy between them and the group with the highest recommendation score (26-100 beds). Press Ganey is less represented among ambulatory facilities surveyed than other entities. Given Press Ganey’s impressive performance in overall rating, this may account for some of the discrepancy.

VENDOR RECOMMENDATION BY TITLE

VENDOR RECOMMENDATION BY BED COUNT

PROVIDER SCORES CONT.

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HCAHPS providers are limited in how they provide their services. The survey is standardized and CMS has other requirements that limit differentiation. So how do hospitals decide which HCAHPS vendor to pick? We examined how important key features are to purchasers and how satisfied hospitals are with their provider on each. We looked at:

•Size of survey sample•Price of service•Reporting functionality / analytics•Customer service•Other proprietary surveys offered

The results suggest different vendors have differing strengths and weaknesses. In addition, the value of features and satisfaction with those features is compared by role of the respondent and the number of beds in their hospital.

BENCHMARKS

SIZE BENCHMARKSHow important is the sample size itself? These results make clear that getting a large sample size is an important consideration for hospitals purchasing HCAHPS no matter which vendor they choose. However, not all vendors receive equal satisfaction for the response rate they provide to their customers. Those findings, along with breakdowns by vendor, title of respondent, and bed count by hospital are included below.

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SIZE OF DATA IMPORTANCE BY VENDOR

SIZE OF DATA SATISFACTION BY VENDOR

BENCHMARKS CONT.While Avatar customers say the amount of HCAHPS data is really important, they are also much more likely to be disappointed with the quantity actually received. No vendor is posting off-the-charts satisfaction ratings on this feature, though, and that could hurt as customers consistently rate this as a very important feature. This represents a pick up opportunity for vendors.

By Vendor

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The size of the data appears to be considered universally important with minimal variation by job title; however, satisfaction changes somewhat depending upon the title of the respondents. Directors of Patient Access seemed very satisfied with the quantity of data provided while other job titles were less impressed.

SIZE OF DATA IMPORTANCE BY TITLE

SIZE OF DATA SATISFACTION BY TITLE

BENCHMARKS CONT.By Title

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BENCHMARKS CONT.The need for, and satisfaction with, a large amount of data seems to be consistent by hospital bed count with minimal variation between facilities of differing sizes. That said, there is clearly a disparity between the two with satisfaction lagging behind importance in the eyes of respondents. This represents a pick up opportunity for an innovative vendor willing to improve.

SIZE OF DATA IMPORTANCE BY BED COUNT

SIZE OF DATA SATISFACTION BY BED COUNT

By Bed Count

PRICE BENCHMARKSMoney makes the world go round, but how important is it in picking an HCAHPS vendor? Conven-tional wisdom suggests that a heavily regulated product (like HCAHPS) will put a premium on price as a feature. These charts suggest conventional wisdom holds in many cases, but some customers are less concerned with pricing than are other hospital leaders. They tend to pick different vendors for HCAHPS. This may have an impact on the differing satisfaction scores as well.

As with many features, there is a gap between perceived importance and satisfaction with the service provided. Vendors should view this as encouragement to step in and try to improve.The charts below explore satisfaction and importance by vendor, job title of respondent, and hospital bed count.

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BENCHMARKS CONT.

PRICE SATISFACTION BY VENDOR

PRICE IMPORTANCE BY VENDOR

Avatar and PRC appear to cater to hospitals that are less concerned with pricing than other facilities; however, satisfaction with the pricing of those two vendors is dramatically different.

On another note, JL Morgan records the highest score among this data point and is the only vendor that matches the satisfaction compared to the perceived importance of pricing.

By Vendor

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BENCHMARKS CONT.

PRICE SATISFACTION BY TITLE

PRICE IMPORTANCE BY TITLE

Job title appears to impact attitudes toward price of HCAHPS. Clinical Directors appear to be much more price conscious than other hospital leaders. However, price satisfaction is significantly higher among Directors of Patient Access than some other roles.

By Title

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BENCHMARKS CONT.Ambulatory facilities are less price conscious than hospitals and less satisfied with pricing. It appears they are willing to settle for a less robust solution but are grumbling in the same breath. Other differences appear to be minimal based on number of beds in a facility.

PRICE IMPORTANCE BY BED COUNT

By Bed Count

REPORTING BENCHMARKSA survey without useful insights is kind of like a dinner plate with no meal in the oven. What exactly is the point? Different vendors provide results in unique formats with different options; these unique features provide the opportunity for vendors to differentiate themselves from one another. This data suggests they have done so to a limited degree.

This section is focused on importance of and satisfaction with these reporting tools. These results detail the perceived importance of reporting functionality, as well as the satisfaction with what is provided by vendor used, title of respondent, and hospital bed count.

As with other features, there appears to be a gap between the perceived importance of reporting tools and satisfaction with these tools. This means the market is open for a vendor to innovate.

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This research detected some differences in reporting depending upon the vendor used. JL Morgan customers see reporting functionality as more important by the slightest margin than customers of other vendors. Satisfaction is largely similar between vendors, but Avatar customers were less satisfied than others.

ANALYTICS/REPORTS IMPORTANCE BY VENDOR

ANALYTICS/REPORTS SATISFACTION BY VENDOR

BENCHMARKS CONT.By Vendor

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Job title appears to make very little difference in perceived importance of reporting functionality, but it does impact satisfaction of the reporting functionality that is provided. Directors of Patient Access are marginally more satisfied than those in other roles.

ANALYTICS/REPORTS IMPORTANCE BY TITLE

ANALYTICS/REPORTS SATISFACTION BY TITLE

BENCHMARKS CONT.By Title

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Hospital bed count appears to have an impact on perceived importance of reporting and analytics functionality, with the smallest facilities seeing this feature as least important and perceived importance abruptly going up at 26+ beds; Ambulatory facilities are also less satisfied with reporting functionality than larger facilities.

ANALYTICS/REPORTS IMPORTANCE BY BED COUNT

ANALYTICS/REPORTS SATISFACTION BY BED COUNT

BENCHMARKS CONT.By Bed Count

CUSTOMER SERVICE BENCHMARKSA fast food franchise once built an entire advertising campaign on letting you “Have it your way.” Since then, many companies have pitched themselves as being customer service-oriented. Clearly that is important to customers of HCAHPS vendors as well; however the level of importance influences the choice of vendor. Overall, it appears that no vendor is achieving high levels of satisfaction on this front.

These results detail importance of customer service and satisfaction with the service provided by vendor, job title of respondent, and hospital bed count.

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Different customers appear to value customer service differently. Satisfaction with customer service is also different depending upon the vendor used.

CUSTOMER SERVICE IMPORTANCE BY VENDOR

CUSTOMER SERVICE SATISFACTION BY VENDOR

BENCHMARKS CONT.By Vendor

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Job title appears to impact interaction with customer service to some degree; Directors of Patient Access place more importance on customer service while also being more satisfied with customer service than any other roles.

CUSTOMER SERVICE IMPORTANCE BY TITLE

CUSTOMER SERVICE SATISFACTION BY TITLE

BENCHMARKS CONT.By Title

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Bed count appears to have an impact on perceived importance of customer service, though satisfaction is similar between various hospital sizes. For an unknown reason, hospitals with 26-100 beds are more satisfied than some other size groups.

CUSTOMER SERVICE IMPORTANCE BY BED COUNT

CUSTOMER SERVICE SATISFACTION BY BED COUNT

BENCHMARKS CONT.By Bed Count

SURVEY BENCHMARKSIsn’t the information from HCAHPS all that people need to know about hospitals? The bureaucrats who wrote the surveys may have thought so, but many hospitals disagree. Instead, many have hired their HCAHPS providers to provide additional surveys that are more flexible and provide more useful information. So how do hospitals proceed with these additional services? This section address that question and shows how one vendor in particular appears to be doing well with that feature. In addition, this section reveals differences in how job title impacts attitudes toward these proprietary surveys.

These questions describe perceived importance of such surveys as well as satisfaction with the service provided by these HCAHPS vendors. As with the rest of the report, the results are broken down by vendor, respondent title, and hospital bed count.

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JL Morgan leads the pack in this feature. It clearly markets to hospitals that prioritize these extra surveys and its customers are more satisfied with the feature overall.

Alternatively, we see Avatar lagging in this area with one of the lowest score recorded across this entire report. Providers looking for a platform that does more than HCAHPS surveys, it appears they are not up to the task. That may work for their business model as there can be truth to the saying, “You can’t be all things to all people.” If they have pulled back on a more diverse offering, then this score doesn’t necessarily show weakness.

PROPRIETARY SURVEYS IMPORTANCE BY VENDOR

PROPRIETARY SURVEYS SATISFACTION BY VENDOR

BENCHMARKS CONT.By Vendor

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Clinical Directors appear to put slightly more emphasis on having a diverse survey offering than other job titles do. This disparity gets wider in terms of satisfaction. It appears this group has the research bug more than titles, with more of an appetite for survey diversity beyond HCAHPS.

PROPRIETARY SURVEY IMPORTANCE BY TITLE

PROPRIETARY SURVEY SATISFACTION BY TITLE

BENCHMARKS CONT.By Title

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Hospital bed count don’t seem to impact attitudes about the importance of proprietary surveys much. This minimal impact is less pronounced among satisfaction, though ambulatory facilities appear to be uniquely less satisfied with proprietary surveys than other facilities.

PROPRIETARY SURVEY IMPORTANCE BY BED COUNT

PROPRIETARY SURVEY SATISFACTION BY BED COUNT

BENCHMARKS CONT.By Bed Count

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CONCLUSIONHCAHPS is mandatory spending for hospitals, but how hospitals choose vendors is up to them. Choosing wisely is important-- the results can influence millions of dollars in CMS reimbursements. So which features matter? How are vendors performing?

This report has answered these questions. Clearly the market matters to hospitals, and satisfaction with services provided varies depending upon feature, vendor, and the nature of hospital / respondent. For example, this report finds a statistically significant difference in recommendation based upon HCAHPS vendor used. One vendor, in particular, is viewed more favorably by its customers than some others are by theirs.

In addition, this report showed that price, sample size, reporting functionality, customer service, and other proprietary surveys are all important features to customers. The mean response for each was above a 4 out of 5. Reporting and customer service were perceived as more important than the other three features, though all ranked highly.

Finally, these results make clear vendors can make a bigger play in the space. This report has identified key areas in which vendors could improve. Satisfaction with each feature tested fell below perceived importance of that feature. This represents an opportunity for vendors.

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APPENDIXArborDEYTAJackson GroupLTRAXRCCNRMSSHP

OTHER VENDORS MENTIONED BY PARTICIPANTS