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CG CAHPS 101

Although first introduced in 2012, there is still a lot of misunderstanding and misinformation around CG CAHPS methodology, timing, and requirements. The following answers to frequently asked questions will help in making better decisions.

What is CG CAHPS?

The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) survey is a standardized survey tool to measure patient perceptions of care delivered by a provider (e.g. physician, nurse practitioner, physician assistant, etc.) in an office setting. The purpose of the survey is twofold:

     ▪ Provide information that clinicians and groups can use to improve care and the patient experience
     ▪ Provide information to consumers to help them select physicians, other providers or medical groups through public reporting

What measures does CG CAHPS include?

There are a number of versions of the CG CAHPS survey available all designed to measure the patient’s overall experience. Although there are optional supplemental items, the core questions measure the following:

     ▪ Timeliness of appointment and care
     ▪ The provider’s communication with the patient
     ▪ Helpfulness and courtesy of the office staff
     ▪ The patient’s overall rating of the provider

Are CG CAHPS mandated?

This survey is not yet a requirement for all types of practices, but it is anticipated that in time, Centers for Medicare and Medicaid Services (CMS) will require the CG CAHPS for full reimbursement. CMS issued the Physician Fee Schedule final rule on Nov. 16, 2012, confirming implementation of CG CAHPS for Physician Quality Reporting System (PQRS) participants as part of the CAHPS for PQRS program. CMS requires CG CAHPS data collection for medical practices with over 100 eligible professionals under one tax identification number who are submitting PQRS through the GPRO web interface and will start voluntary participation for groups with least 25 eligible professionals in 2015. Both Pioneer Accountable Care Organizations (ACO) and Medicare Shared Savings Program ACOs are required to participate in annual CG CAHPS data collection as part of the ACO CAHPS program.

     ▪ Medical practices with more than 100 providers under one tax identification number and participate in Physician Quality Reporting System through the GPRO
       web-interface are required to participate in CG CAHPS; reporting will impact their value modifier (VM) payment in 2016.
     ▪ The 2014 proposed rule states that PQRS CG CAHPS participation would be voluntary for groups over 25 providers and could be selected as one of the                      areas calculating VM for practices over 100, regardless of how they submit PQRS data.
     ▪ Also, the CG CAHPS instrument has been selected for evaluating the patient experience as part of both the Pioneer ACOs
       program and the Medicare Shared Savings Plan ACO program.

How is this relevant to my practice? Does it affect my reimbursement?

CG CAHPS is relevant to your practice from both a financial and reputational standpoint. Once CG CAHPS is mandated, a portion of your Medicare reimbursement will be withheld if you have not begun implementation. In addition, your practice’s scores and results will be publicly reported, so you will want to make sure your scores are favorable.

By 2015, reimbursement will be tied to CG CAHPS scores for some practices. For Pioneer and MSSP ACOs, 25% of their quality results will be based on CG CAHPS and ultimately impact their ability to share in savings. For medical practices impacted by CG CAHPS, at least 16.7% of value-based dollars will be based on CG CAHPS as part of the Value Modifier (VM).

If CG CAHPS isn't mandatory, why should I start now?

Arguably the most comprehensive study done on the subject summarized evidence from 55 different studies. The study found consistent positive associations between patient experience and:

     ▪ Self-rated and objectively measured health outcomes
     ▪ Adherence to recommended clinical practice and medication
     ▪ Preventive care (such as health-promoting behavior, use of screening services and immunization)
     ▪ Resource use (such as hospitalization, length of stay and primary-care visits)