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Maura Cash – Proactively Improving Your OAS-CAHPS Results
87 Plays7 months ago
One of our favorite returning guests, Maura Cash, is here today to talk about OAS-CAHPS. There is a ton of OAS-CAHPS coverage right now across the industry, given the 2025 mandated deadline, but we'll cover a new angle with Maura: how you can proactively improve your scores before they become public by properly training your staff.
After my conversation with Maura, we'll switch to our Data & Insights segment. Today, we'll break down the average Patient Deposit Collection Rates that surgery centers are experiencing, and then I'll share some tips for how you can improve those collection rates.
Resources Mentioned:
Download HST’s State of the Industry Report to get your hands on even more data: https://www.hstpathways.com/resources/surgery-center-industry-report
Brought to you by HST Pathways.
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Transcript
Podcast Introduction
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
00:00:28
Speaker
Hi everyone, here's what you can expect on today's episode.
Understanding OAS Caps with Maura Cash
00:00:32
Speaker
One of our favorite returning guests, Maura Cash, is here today to talk about OAS caps. So I know there is a ton of OAS caps coverage right now across the industry given the 2025 mandated deadline, but I was recently chatting with Maura and she had mentioned a new angle that I haven't seen anyone covering yet.
00:00:53
Speaker
which is how you can proactively start improving your scores before they become public. So everyone knows that you want to improve your scores before they become public, but Mora's here today to share with us some tangible tips as to how you can actually do so.
00:01:10
Speaker
And after my conversation with Maura, we'll switch to our data and insight segment. Today we'll break down the average patient deposit collection rates that surgery centers are experiencing. And then I'll share some tips for how you can improve those collection rates too. Hope everyone enjoys the episode and here's what's going on this week in surgery centers. Hi, Maura. Thanks for coming on the podcast again. Happy to be here.
00:01:39
Speaker
Thanks for asking. Yeah. So in case our listeners miss your first two episodes, can you share a little bit about yourself and your healthcare background, please? Well, I've been a nurse for 45 years, which was as long as it sounds, but lucky enough to spend the last 20 years in the ASC space.
00:01:59
Speaker
Nice. We were talking recently and the subject of OAS caps came
Preparing Staff for OAS Caps Survey
00:02:05
Speaker
up. I know there's a ton of coverage of this right now from Ask a Becker's, all the vendors, news outlets, but when we were chatting, you had mentioned a new angle that I hadn't seen anyone covering yet, which is why I definitely wanted you to come on. You were talking about
00:02:23
Speaker
actually how you can prepare your staff so that you can get the best results from the survey. That will be the bulk of the conversation, but first, let's just breeze through some of the logistics just to set a foundation here. Can you give us a brief history of OAS caps and when it will become mandatory? OAS caps has been hanging around in the background for quite a long time, quite a number of years.
00:02:50
Speaker
I think 2016 around, but it was never mandatory in the ASC space. It will become mandatory in 2025. And if you haven't started down the journey of setting yourself up for OAS caps, you cannot delay. You must do it now. This year is the opportunity to get it set up, see what some preliminary results are before they get reported.
00:03:20
Speaker
the survey itself, learn it, understand it, know how many you're getting in, choose your vendor. All of those things need to be done in advance. You cannot afford to wait much longer.
00:03:34
Speaker
Yeah. When I was doing a little research for this discussion, I had found an article, I think it was 2017 from Outpatient Surgery magazine, introducing it and just kind of actually saying the exact same thing of start now.
Navigating OAS Caps Survey Challenges
00:03:48
Speaker
And there was a ton of management groups that had rolled out pilots and then kind of backtracked because the date kept pushing. So I definitely don't think this subject is going to be new news to anybody, but I think it's, you know, we're two points. It's time.
00:04:02
Speaker
It's not, but I think a lot of centers were hoping that it would just remain voluntary. And that's because it's expensive. It's time consuming. Many ASCs are already asking these questions and benchmarking them. And it just seems a little redundant for them to spend the money, the time, the effort, the energy to get this done. Yeah, totally get it. So the survey itself.
00:04:30
Speaker
The questions are predetermined. What are the approved methods of collection? Well, absolutely the questions are predetermined. Not only are they predetermined, but they cannot be changed at all. Even when they're one of the approved methods, of course, is phone call. Even when you're on the phone with the patient and you realize maybe their grasp of English is limited.
00:04:58
Speaker
You can't even explain the question in other words. You must use the words that they give you to say. So currently it's via phone, email phone combo for those patients who could not complete the email survey. And now electronic submission as well, which is also paired with the phone so that they can follow up with the patients who fill out the form and maybe don't complete it electronically.
00:05:26
Speaker
Sure. Yeah. And I think, gosh, the fact that they're not allowing online collections of these surveys is such a miss, but it is what it is. Right. And it's tough because 200 surveys for each ASC over a 12-month period is reported. So that's a lot. That's a lot of people to answer, quite frankly, a lot of questions. And I think there's about 30, 31 questions that they have to answer.
00:05:56
Speaker
And, you know, if I get a survey on my phone or in my email box and it says, would you take the time to answer the survey? Most of the time I'm going to say no. And if I do say yes and I look at it, the survey should take 15 minutes to complete. I'm like, no. Yeah, forget it. So that, that was another reason ASCs gave
00:06:19
Speaker
for not as many completed surveys to be required and the hospital requires 300. So we did get a little break there, but that's a lot. It's a lot of surveys. Yeah, totally.
Reporting and Penalties for OAS Caps Surveys
00:06:32
Speaker
So let's talk about the approved vendors and kind of the story behind that because we get questions all the time. Why is an HST an approved vendor or some of the other leading software vendors on the list? So give us a little backstory there. So software vendors like HST
00:06:48
Speaker
We have a vested interest in our clients' outcomes. Not that we would skew the results, but the ability and the possibility to do so is there if we were to be administering the survey that we're then submitting. So in order to remove all opportunity for impropriety, it is a third party
00:07:15
Speaker
non-biased survey specialists that are vetted and approved by CMS to administer the survey. And that's who you must use. In addition to that, which our clients probably don't care so much about, it would take an entire new division of HST of
00:07:38
Speaker
phone call people, email people, statistical people to submit, gather and put all that data in the proper format for CMS. So we currently focus on the software for the ASCs that they're going to use in the day in the life of the patient from soup to nuts. So the software vendor must be a third party, non-biased individual. So
00:08:07
Speaker
HST and companies like HST, we just don't qualify. Yep. Yeah. And that makes a ton of sense. And we'll include the approved vendors list in the episode notes. I think obviously press gaining is the most popular one, I think, but I think there's 16 on there the last time I checked. So there are options. We all have different prices and it behooves you to find out what they're going to give you, what their price is.
00:08:33
Speaker
And can you add some of your own questions, which will eliminate your need for a post-op survey at your center. That kind of information that you collect on most of your patients, you might be able to put out into that, their survey. Of course it makes the survey longer. So, you know, that's a catch 22, but you have to remember that this is thrust upon us and we have to follow the rules for it.
00:09:01
Speaker
Yep. And speaking of, if you do not follow the rules, what is the penalty for not reporting or participating? So there's a 2% Medicare payments for each year. The center does not report results. And that's true for all of the quality measures. So if you don't report this year, you'll get a 2% cut in your Medicare payments. If you don't next year, you're up to 4%, 6%, 8%. It doesn't stay at 2%.
00:09:29
Speaker
cumulative. So if your center has a very small Medicare population and you would rather take the small cut and pay the fee for a vendor to administer the survey, that's an internal financial decision. And I encourage you to look at it. I mean, if you're a cataract center or an eye center, majority of your patients are Medicare would not behoove you to miss this study. But if you do
00:09:57
Speaker
you know, pediatric cases or plastics and they're all cash pay. Maybe it doesn't behoove you. So nothing to think about. Yeah. No, that's interesting. Okay. Let's talk about improving the results now. So we mentioned it a little bit earlier, but what are the benefits of starting ASAP and before it's required? Well, for one, you get an idea of where your center is lacking in that patient experience. So you can improve it.
00:10:27
Speaker
before it's reported and then made public. That's kind of a big win. You're able to get the survey results as soon as you start it and set it up. And then you can even create a QAPI study for it, right? Two birds with one stone. So if you find out that you have a problem with a patient experience question, you can work on improving that so that when it is reported, you've improved it, but you also have a QAPI study for this year.
00:10:58
Speaker
So that is super helpful. It also introduces the study and the verbiage and the results of what they look like to your team. And I encourage you not to go this alone. Use the team. Make sure everybody in your center is aware that this is happening, not just the people who have to gather the data and report it.
00:11:26
Speaker
Sure. Yeah, I wish I remember the center, but when I was doing some research, I was reading about a surgery center that has started early and they realized they were having a lot of issues with their discharge instructions, which they weren't even really privy to. So they were able to fix those discharge instructions and improve.
00:11:45
Speaker
before it went public. Exactly. Exactly. And I think it's interesting too with the survey, how many questions have to do with the patient experience outside of the surgery center? Like I feel like we're always kind of hyper focused on the moment they arrive to the moment they leave, but there are so many questions that have nothing to do with them inside your walls. So it's a lot to prep.
00:12:08
Speaker
Yeah, it is.
Enhancing Patient Survey Experience
00:12:10
Speaker
But as long as you've got the language down and everyone is aware that these are the questions that are going to be asked, you know, like I would train my staff. Yeah. And okay. Let's dive into that. How, what do you suggest there in terms of training your staff? You know, I'd start out with a staff meeting, whether you hold them at your center, weekly, monthly, however, but I would call a staff meeting, make it mandatory.
00:12:37
Speaker
Explain OAS CAHPS that it's not a survey about you and how you perceive your center. It's the patient experience survey. And so their experience can be very different. As we all know, a patient can be called in the lobby and then they're just going to say the place was freezing. I was freezing the whole time.
00:13:01
Speaker
Meanwhile, as soon as they got into the preop area, you loaded them down with blankets and you kept them warm and they stayed warm. That first impression, you know, mattered. But I would set that first meeting. I would make sure all the staff, the anesthesia, the surgeons, the providers have a copy of the questions and let them take the survey as if they were going to be a patient and see what they think of themselves.
00:13:31
Speaker
I would let them take it and understand the whys and hows of the survey. And then the most important thing to me, which was shared to me by another nurse colleague actually at an association meeting, is that she had to revamp the way their nurses and their staff ask the patients how they're doing, right? So if they read the questions, then they understand
00:14:00
Speaker
how that question will be phrased. And they're able to say things like, instead of going in and saying, hey, Erica, how you doing? You doing OK? And you say, yep, I'm doing OK. The survey doesn't ask, did the staff ask you if you're doing OK? The survey asks, was the staff within the facility courteous and provided you extra care and explanations?
00:14:30
Speaker
The word courteous, I know that word, you know that word. Does somebody whose English isn't first language for them understand the word courteous? So use the words that the survey will ask the patient. Were you given instructions specifically about nausea and vomiting? We all give them discharge instructions, but do we stress the words that they're going to be asked about bleeding, infection, nausea, and vomiting, pain? We all address that.
00:15:00
Speaker
but maybe bold it in your instructions, maybe go over it pre-op when the patient is awake and alert because giving the instructions to the significant other doesn't really help because they're not taking the survey. So you have to keep in mind when is best to give the discharge instructions, when it's best to explain to the patient what their journey through your center is going to be.
00:15:28
Speaker
So I would make sure that your team, including your anesthesia team is asking the patient the same question that the survey is going to ask the patient. They can use it differently, but if I get asked a month later, did anesthesia, the person who puts you to sleep or blah, blah, blah.
00:15:53
Speaker
ask you if you had any further questions about, explain fully to you the blah, blah, blah, say that I'm your anesthesia provider. I'm going to either put you to sleep or give you a pain block. And I'm going to explain to you all of the, like say what you're going to do in the words that the survey asks you to.
00:16:18
Speaker
And then it will all start to click and that takes time. It takes time to change people's pattern of speech. Another reason to start now. And you can even share these questions now before you even have a provider set up because it doesn't matter who your vendor is. They have to ask the same questions in the same order in exactly the same way. Yep.
00:16:41
Speaker
Yeah. And I think what's interesting reading through the questions is there's so much about frequency. Like I think when we think patient satisfaction survey, we think, oh, how well did we do something? But there's so many questions that are like focused on frequency. How many times? Like it's just a really different way of thinking about the patient experience. And to your point, you can go download a copy of this survey at any time. So while you're.
00:17:07
Speaker
maybe evaluating vendors, you could still be preparing before you even know who your vendor is. Exactly. Yeah. And you had mentioned the anesthesiologist, which I think is interesting because if I remember correctly, I think there's four questions that are related to anesthesia within the survey. And you have to talk to your anesthesia groups about this and make sure that, and your physicians, of course, that you're all on the same page. Yeah.
00:17:35
Speaker
They might be more difficult to convince about the importance. So if you're doing your survey now and you get the results back and you could share it with that team and say, see, they're not understanding your anesthesia team and they're not completely picking up on what it is you're trying to tell them. They understood it when the anesthesia team spoke to them, but they didn't understand it when the question was asked of them.
00:18:06
Speaker
because the question was phrased differently. So we have to keep in mind questions that are gonna be asked so that we know we are answering that question for them. So when they get surveyed and they're asked, did your anesthesia provider speak to you about all of the consequences, blah, blah, blah, blah, blah, and you say, yeah, I remember him saying that, right? I remember her explaining that to me because he used the same words.
00:18:36
Speaker
Yep. And I think the anesthesia piece of it is interesting too, because one, they know your anesthesia group has a vested interest in you, but not necessarily your survey results, right? Yeah. So I think that's kind of tough too. You know, obviously any partner is going to care, but I think it's, you know, might take some more time to get them on board with tweaking their language and processes. I remember they don't, if it's just a no go, they're not playing along.
00:19:06
Speaker
It is possible to have the nurse who's witnessing the anesthesiologist explain it to them just to reiterate when that provider is finished to say, did the anesthesiologist, you can ask the question, you can ask the survey question of your patient while they're at your facility. So you can say, did the anesthesia provider who was just here explain to you blah, blah, blah, blah, blah, whatever the question is.
00:19:36
Speaker
And then they'll be able to say yes. And then when they hear that question again, they'll say, oh yeah, the nurse asked me that. Yes. Yep. Perfect. Are there any operational areas that you would anticipate ASCs might need to tweak based on, you know, your experience and the survey? Yeah. The survey questions include the phrase like easy to understand.
00:20:03
Speaker
in relationship to the pre-data service and post-data service communications. So I would make sure that your discharge instructions address, include information about pain, nausea, vomiting, infection, stress those instructions, make sure the patient is awake to hear your words, the family members are not sufficient here. Those kinds of micro changes
00:20:33
Speaker
introduced over the next nine months will set you up for success. Thank you. All right, Maura. Last question. We do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers? Listen to your podcast, Erica.
00:20:55
Speaker
I like it. Well, all I can say is keeping in line with the OAS caps. Many of us are not happy with the burden. Both financial and education will incur with this survey. But we need to look at the silver lining. Learn what you can, then use it to improve the patient experience at your center. Because while CMS is focused on collecting data,
00:21:24
Speaker
for the patient experience. The center is focused on the actual patient experience. So use the data. Don't just, oh, we have to sign up for the survey. Okay, we picked this vendor and they're gonna do it. Now they're gonna send in the results and that's great, we're done here. Use the survey results to make incremental changes so that your patients always walk away saying, that is the best procedure I've ever had.
00:21:54
Speaker
And there are good and there are bad, and there are levels of good and bad. And as long as you are eking your patients up the chain to the best level that you can be, I think that it's a win. That is great advice. Thank you, as always, for coming on, Maura. We appreciate it. It's a pleasure, Erica.
Data and Insights on ASC Performance
00:22:20
Speaker
Welcome to Data and Insights, where we turn data into dialogue and numbers into narratives. As you probably and hopefully know by now, HSC Pathways released a State of the Industry report late last year, highlighting best practices, key process steps, and KPIs for every step of the patient journey and for nearly every recurring administrative duty.
00:22:43
Speaker
Most importantly, using our own unique dataset from our clients, we were able to extract data points so that anyone in the industry could compare themselves to their peers. To disclaimers, we only pulled data from clients who gave us permission and we omitted any extreme outliers.
00:23:00
Speaker
So after analyzing data from over 450 ASCs across the country, we determined that a typical ASC only collects 53% of expected patient deposits at the time of service. And just to clarify, that doesn't mean they collected 53% of the total owed amount for their procedure, just 53% of what they would have expected the patient deposit to be.
00:23:27
Speaker
Our analysts derive this metric by simply dividing the actual patient deposit collected by the expected patient deposit. So why does this data point matter? Why is this important to track? Effective deposit collection is a critical component of the revenue cycle. The more you can collect upfront, the more you can reduce your outstanding balances, minimize bad debt, reduce the amount of time you have to spend on the backend following up with patients.
00:23:55
Speaker
Minimize the number of patients you have to send to collections and just save yourself so much headache. The list goes on, but obviously collecting as much that you can before the procedure even happens is critical.
00:24:11
Speaker
How can you improve your patient deposit collection rates? The financial aspect of a surgery often causes just as much anxiety for patients and their families as the procedure itself does. Trying to navigate the complexities of how much insurance will cover, what will need to be paid out of pocket and by when, hoping surprise bills don't show up weeks or months later, it's all extremely daunting and overwhelming for the average consumer.
00:24:39
Speaker
So the key to this is providing patients with an accurate financial estimate as far out from their date of service as possible. As soon as you have that scheduled case, an estimate should go out as soon as you possibly can, you know, same day, 24 hours, however quickly you can get it out.
00:24:57
Speaker
This allows the patients to plan better and prepare, and it also enables them to trust you, which is the second key to this. So I think the two main factors, or there's kind of three, but two for now, are providing the estimate as soon as you possibly can, far as advanced out as possible, and then building that trust. It's really the trust that is key to all of this. If they don't trust the estimate that they receive and they don't trust you, they are way less likely to pay.
00:25:26
Speaker
So, sending the estimate via text, email, or discussing over the phone will allow you to build trust, collect more upfront payments, reduce last minute cancellations,
00:25:37
Speaker
and improve patient satisfaction scores. And speaking of patient satisfaction scores, questions related to finances and payments are often the lowest scores that ASCs receive. And with OAS caps coming down the pike, which we just heard from Maura earlier in the episode, you need to have full transparency with your patients and have your collections workflows buttoned up.
00:26:00
Speaker
In order to get those estimates out timely and accurately though, you really need to use technology so you can generate accurate patient estimates in minutes, send the estimate to the patient via text or email and allow them to submit payment via credit card from the comfort of their home. So that's that third component that I had referred to earlier. So for me, three tips to improve your collection rates, get that estimate out as soon as possible.
00:26:26
Speaker
build that trust with the patient as soon as possible and then allow them, you know, as soon as they received that estimate, there should be a button that says click now and they could pay in whichever way you want them to payment plans, whatever it might be. And also I think it's really important that estimate and the conversations that you have with your patients are super easy to read, devoid of any medical jargon as much as possible and include a very clear breakout of payer versus patient responsibility.
00:26:56
Speaker
And hopefully you're all already know this, but as a rule of thumb, a patient should never hear what they owe for the first time when they walk in on the day of surgery. This will not only increase patient deposit rates, but we'll foster trust, avoid surprise billing and contribute to an overall positive experience. You can get those satisfaction scores up.
Episode Conclusion
00:27:18
Speaker
So if you're interested in more data points and use cases, subscribe to our podcast so that you don't miss any upcoming data segments, or you can always head to our website to check out the full state of the industry report to get your hands on even more data. And that officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we will see you again next week.