This Week in Surgery Centers: Maura Cash – Proactively Improving Your OAS-CAHPS Results

Maura Cash – Proactively Improving Your OAS-CAHPS Results

Here’s what to expect on this week’s episode. 🎙️

Understanding and preparing for OAS-CAHPS is not just necessary but urgent. With the mandatory reporting deadline under ten months away, how are you proactively improving your scores before they become public by properly training your staff?

One of our favorite returning guests, Maura Cash, is here today to tell you how to prepare your teams for the upcoming OAS-CAHPS requirements and ensure a smooth transition into the new mandatory survey period. Here are the tips she shared:

1. Mandatory Staff Meetings: Begin with mandatory staff meetings to discuss OAS-CAHPS, ensuring every team member understands its significance and the impact of patient experience surveys. It’s vital that the training is not isolated to the administrative team but encompasses all staff, including nurses, surgeons, and anesthesiologists.

2. Engage with the Survey: Encourage staff to take the survey themselves. This exercise allows them to step into the patients’ shoes, offering insights into the patient experience and highlighting areas for improvement from a new perspective.

3. Review and Role-play: Distribute copies of the survey questions to all staff members. Conduct role-playing exercises to practice how they would respond to patient inquiries and concerns, aligning with the survey’s language and focus areas. This helps embed the patient experience into everyday interactions and ensures the staff is well-versed in the survey’s content.

4. Focused Training on Communication: Emphasize the importance of language and communication. Train staff to use specific phrases and terms from the survey during patient interactions, ensuring clarity and consistency in communication. Highlight the difference between casual inquiries about a patient’s well-being and the structured, survey-aligned questioning that impacts patient responses.

5. Continuous Feedback and Improvement: Implement a system for regular and continuous improvement based on survey results and patient feedback. Encourage an open environment where staff can discuss encounters and experiences, fostering a culture of learning and patient-centric care.

6. Integrate Survey Themes into Daily Operations: Make the OAS-CAHPS survey themes part of the daily operational language. For instance, emphasize cleanliness, communication about medications, and post-discharge care in staff conversations and protocols.

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.

Episode Transcript

0:01
Welcome to This Week in Surgery Centers.

0:03
If you’re in the ASC industry, then you’re in the right place.

0:07
Every week, we’ll start the episode off by sharing an interesting conversation we had with our featured guest, and then we’ll close the episode by recapping the latest news impacting surgery centers.

0:17
We’re excited to share with you what we have.

0:19
So let’s get started and see what the industry’s been up to.

0:28
Hi everyone.

0:29
Here’s what you can expect on today’s episode.

0:32
One of our favorite returning guests, Maura Cash, is here today to talk about OAS-CAHPS.

0:38
So I know there is a ton of OAS-CAHPS coverage right now across the industry given the 2025 mandated deadline.

0:46
But I was recently chatting with Maura and she had mentioned a new angle that I haven’t seen anyone covering yet, which is how you can proactively start improving your scores before they become public.

0:59
So everyone knows that you want to improve your scores before they become public.

1:04
But Maura’s here today to share with us some tangible tips as to how you can actually do so.

1:10
And after my conversation with Maura, we’ll switch to our data and insights segment Today.

1:15
We’ll break down the average patient deposit collection rates that surgery centers are experiencing.

1:20
And then I’ll share some tips for how you can improve those collection rates too.

1:25
Hope everyone enjoys the episode.

1:27
And here’s what’s going on this week in surgery centers.

1:34
Hi, Maura.

1:35
Thanks for coming on the podcast again.

1:37
Happy to be here.

1:39
Thanks for asking.

1:40
Yeah.

1:41
So in case our listeners miss your first two episodes, can you share a little bit about yourself and your healthcare background, please?

1:49
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.

1:59
Nice.

2:00
And we were talking recently and the subject of OAS-CAHPS came up.

2:05
And I know there’s a ton of coverage of this right now from Aska, Becker’s, all the vendors, news outlets.

2:12
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.

2:21
And you were talking about actually how you can prepare your staff so that you can get the best results from the survey.

2:28
So that will be the bulk of the conversation.

2:31
But first, let’s just breeze through some of the logistics, just to set a foundation here.

2:36
Can you give us a brief history of OAS-CAHPS and when it will become mandatory?

2:42
So OAS-CAHPS has been sort of hanging around in the background for quite a long time, quite a number of years I think 2016 around, but it was never mandatory in the ASC space.

2:56
It will become mandatory in 2025.

3:00
And if you haven’t started down the journey of setting yourself up for OAS-CAHPS, you cannot delay, you must do it now.

3:12
This year is the opportunity to get it set up, see what some preliminary results are before they get reported.

3:20
The survey itself, you know, learn it, understand it.

3:25
Know what?

3:25
How many you’re getting in.

3:27
Choose your vendor.

3:28
All of those things need to be done in advance.

3:31
You cannot afford to wait much longer.

3:34
Yeah.

3:34
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 And you know and there was a ton of management groups that had rolled out pilots and then kind of backtracked because the date kept pushing.

3:54
So I definitely don’t think this subject is going to be new news to anybody.

3:58
But I think it’s, you know, we’re two points.

4:01
It’s time.

4:02
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 AS CS 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.

4:26
Yeah, totally get it.

4:28
So the survey itself, the questions are predetermined.

4:32
What are the approved methods of collection?

4:36
Well, absolutely.

4:38
The questions are predetermined.

4:40
Not only are they predetermined, but they cannot be changed at all, even when they’re.

4:46
One of the approved methods, of course, is phone call.

4:49
Even when you’re on the phone with the patient and you realize maybe their grasp of English is limited, you can’t even explain the question.

5:00
In other words, you must use the words that they give you to say so.

5:07
Currently it’s via phone, e-mail, phone combo for those patients who could not complete the e-mail 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.

5:26
Sure, yeah.

5:27
And I think this, the fact that they’re not allowing online collections of these surveys is such a mess, but it is what it is.

5:35
So yeah, and it’s tough because 200 surveys for each ASC over a 12 month period is reported.

5:44
So that’s a lot, that’s a lot of people to answer quite frankly, a lot of questions.

5:52
And I think there’s about 3031 questions that they have to answer.

5:56
And you know, if I get a survey on my phone or in my e-mail box and it says would you take the time to answer the survey?

6:04
Most of the time I’m going to say no.

6:05
And if I do say yes and I look at it, the survey should take 15 minutes to complete.

6:12
I’m like no, yeah, forget it.

6:15
So that that was another reason AS CS gave for not as many completed surveys to be required to the hospital requires 300.

6:25
So we did get a little break there, but that’s a lot, It’s a lot of surveys, yeah, totally.

6:32
So let’s talk about the approved vendors and kind of the story behind that because we get questions all the time, you know, why is an HST an approved vendor or some of the other leading software vendors on the list.

6:43
So give us a little, yeah.

6:45
So software vendors like HST, we have a vested interest in our clients outcomes.

6:52
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.

7:07
So in order to remove all opportunity for impropriety, it is a third party non biased survey specialists that are vetted and approved by CMS to administer the survey and that’s who you must use in.

7:27
In addition to that, which our clients probably don’t care so much about, it would take an entire new division of HST of phone call people, e-mail mail people, statistical people to submit, gather and and put all that data in the proper format for CMS.

7:48
So we currently focus on the software for the AS, CS that they’re going to use in the day in the life of the patient from soup to nuts.

7:59
So the software vendor must be a third party, non biased individual.

8:06
So HST and companies like HST, we just don’t qualify.

8:12
Yep.

8:13
Yeah, and that makes a ton of sense.

8:14
And we’ll include the approved vendors list in the episode notes, I think obviously press gainey is the most popular one I think, but I think there’s 16 on there the last time I checked.

8:25
So there are options.

8:26
We all have different prices and it behooves you to find out what they’re going to give you, what their price is and can you add some of your own questions which will eliminate your need for a post op survey at your center.

8:40
That kind of information that you collect on most of your patients, you might be able to put out into that their survey.

8:48
Of course it makes the survey longer, so you know that’s a catch 22.

8:53
But you have to remember that this is thrust upon us and we have to follow the rules for it.

9:02
Yep.

9:02
And Speaking of if you do not follow the rules, what is the penalty for not reporting or participating?

9:09
So there’s a 2% Medicare payments for each year the center does not report results.

9:14
And that’s true for all of the quality measures.

9:16
So if you don’t report this year, you’ll get a 2% cut in your Medicare payments.

9:23
You don’t next year, you’re up to 4%, six percent, 8%.

9:27
It doesn’t stay 2%.

9:28
It’s cumulative.

9:30
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.

9:45
And I encourage you to look at it.

9:48
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.

9:55
But if you do, you know, pediatric cases or plastics and they’re all cash pay, maybe it doesn’t behoove you.

10:04
So nothing to think about.

10:06
Yeah.

10:07
No, that’s interesting.

10:09
OK, Let’s talk about improving the results now.

10:13
So we mentioned it a little bit earlier, but what are the benefits of starting ASAP and before it’s required?

10:21
Well, for one, you get an idea of where your center is lacking in that patient experience so you can improve it before it’s reported and then made public.

10:30
That’s kind of a big win.

10:32
You’re able to get the survey results as soon as you start it and set it up.

10:38
And then you can even create a coffee study for it, right?

10:43
Two birds with one stone.

10:45
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.

10:55
But you also have a coffee study for this year, so that is super helpful.

11:01
It also introduces the study and the verbiage and the results of what they look like to your team.

11:10
And I encourage you not to go this alone.

11:14
Use the team.

11:15
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.

11:26
Sure.

11:27
Yeah, I wish I remember the center.

11:28
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.

11:41
So they were able to fix those discharge instructions and improve before it went public.

11:46
So exactly.

11:47
Yeah.

11:48
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?

11:56
Like, I feel like we’re always kind of hyper focused on the moment they arrive to the moment they leave.

12:00
But there are so many questions that have nothing to do with them inside your walls.

12:05
So it’s a lot to prep.

12:08
Yeah, it it is.

12:10
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.

12:22
Yeah.

12:23
And OK, let’s dive into that.

12:24
How, what do you suggest there in terms of training your staff?

12:28
You know, I’d start out with the staff meeting, whether you hold them at your center weekly, monthly, however, but I would call a staff meeting, make it mandatory, explain OAS-CAHPS that it’s not a survey about you and how you perceive your center, it’s the patient experience survey.

12:48
And so their experience can be very different.

12:52
As we all know, a patient can be cold in the lobby and then they’re just they’re just going to say the place was freezing, I was freezing the whole time.

13:01
Meanwhile, as soon as they got into the pre op area, loaded them down with blankets and you kept them warm and they stayed warm.

13:08
That first impression you know mattered.

13:11
But I would set that first meeting.

13:14
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.

13:31
I would let them take it and understand the whys and hows of the survey.

13:37
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 asked the patients how they’re doing, right?

13:56
So if they read the questions, then they understand 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?

14:12
You doing OK?

14:12
You say, Yep, I’m doing OK.

14:15
The survey doesn’t ask, did the staff ask you if you’re doing OK, right.

14:19
The survey asks, was the staff within the facility courteous and provided you extra care and explanations like the word courteous?

14:32
I know that word.

14:32
You know that word.

14:33
Does somebody who’s English is the first language for them not understand the word courteous?

14:38
So use the words that the survey will ask the patient.

14:44
Were you given instructions specifically about nausea and vomiting?

14:49
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?

14:59
We all address that, 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 ’cause they’re not taking the survey.

15:17
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.

15:28
So I would make sure that your team, including your anesthesia team, is asking the patient the same question, but the survey is going to ask the patient.

15:41
They can use it differently.

15:44
But if I get asked a month later, did anesthesia, the person who puts you to sleep or blah blah blah ask you if you had any further questions about explain fully to you the blah blah blah, say that I’m your anesthesia provider.

16:03
I’m going to either put you to sleep or give you a pain block.

16:07
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, and then it will all start to click.

16:20
And that takes time.

16:21
It takes time to change people’s pattern of speech.

16:24
Another reason to start now.

16:27
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.

16:41
Yep.

16:41
Yeah.

16:42
And I think what’s interesting reading through the questions is there so much about frequency like I think when we think patient satisfaction survey, we think oh, how well did we do something.

16:52
But there’s so many questions that are like focus on frequency, how many times like it’s just a really different way of thinking about the patient experience.

17:01
And to your point you can go download a copy of this survey at any time.

17:06
So while you’re maybe evaluating vendors, you could still be preparing before you even know who your vendor is exactly.

17:14
Yeah.

17:15
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.

17:26
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.

17:34
Yeah.

17:34
And they might be more difficult to convince about the importance.

17:41
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.

17:58
They understood it when the anesthesia team spoke to them, but they didn’t understand it when the question was asked of them because the question was phrased differently.

18:09
So we have to keep in mind questions are going to be asked so that we know we are answering that question for them.

18:17
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.

18:26
And you say, yeah, I remember him saying that.

18:30
Right.

18:30
I remember her explaining that to me because he used the same words.

18:36
Yeah.

18:37
And I think the anesthesia piece of it is interesting too, because one, they don’t.

18:41
Your anesthesia group has a vested interest in you, but not necessarily your survey results.

18:47
Right.

18:48
It doesn’t outline fires.

18:50
Yeah.

18:50
Yeah.

18:51
So I think that’s kind of tough to, 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.

19:02
And remember they don’t if it’s just a no go, they’re not playing along.

19:06
It is possible to have the nurse who’s witnessing the anesthesiologist explain it to them.

19:12
Just to reiterate, when that provider is finished to say, did the anesthesiologist, you can ask the question.

19:21
You can ask the survey question of your patient while they’re at your facility?

19:26
Yeah.

19:27
So you can say, did the anesthesia provider who was just here explain to you, blah, blah, blah, blah, blah, whatever the question is?

19:36
And then they’ll be able to say yes.

19:38
And then when they hear that question again, they’ll say, oh, yeah, the nurse asked me that.

19:42
Yes.

19:44
Yep.

19:44
Perfect.

19:46
Are there any operational areas that you would anticipate AS CS might need to tweak based on, you know, your experience and the survey?

19:57
Yeah, the survey questions include the phrase like easy to understand in relationship to the pre date of service and post date of service communications.

20:09
So I would make sure that your discharge instructions address.

20:16
Include information about pain, nausea, vomiting, infection, stress.

20:21
Those instructions make sure the patient is awake to hear your words.

20:26
The family members are not sufficient here.

20:30
Those kinds of micro changes introduced over the next nine months will set you up for success.

20:41
Thank you.

20:42
All right, Maura, last question.

20:44
We do this every week with our guests.

20:46
What is one thing our listeners can do this week to improve their surgery centers?

20:51
Listen to your podcast, Erica.

20:55
I like it.

20:57
Well, all I can say is keeping in line with the OAS-CAHPS, many of us are not happy with the burden both financial and education will incur with this survey.

21:08
But we need to look at the silver lining, learn what you can, then use it to improve the patient experience at your center.

21:17
Because while CMS is focused on collecting data for the patient experience, the center is focused on the actual patient experience.

21:31
So use the data, don’t just, oh, we have to sign up for the survey, OK.

21:36
We picked this vendor and they’re going to do it.

21:38
And then when they’re going to send in the results and that’s great.

21:40
We’re done here.

21:42
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.

21:54
And there are good and there are bad and there are levels of good and bad.

21:58
And as long as you are eeking your patients up the chain to the best level that you can be, I think that it’s a win.

22:10
That is great advice.

22:11
Thank you as always for coming on, Maura.

22:13
We appreciate it.

22:15
It’s a pleasure.

22:16
Erica, welcome to Data and Insights, where we turn Data into dialogue and numbers into narratives.

22:27
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.

22:43
Most importantly, using our own unique data set from our clients, we were able to extract data points so that anyone in the industry could compare themselves to their peers.

22:53
Two disclaimers, we only pulled data from clients who gave us permission and we omitted any extreme outliers.

23:00
So after analysing data from over 450 AS CS across the country, we determined that a typical ASC only collects 53% of expected patient deposits at the time of service.

23:14
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.

23:26
Our analysts derive this metric by simply dividing the actual patient deposit collected by the expected patient deposit.

23:34
So why does this data point matter?

23:37
Why is this important to track?

23:39
Effective deposit collection is a critical component of the revenue cycle.

23:44
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 back end following up with patients, minimize the number of patients you have to send to collections, and just save yourself so much headache.

24:00
The list goes on, but obviously collecting as much that you can before the procedure even happens is is critical.

24:09
So how can you improve your patient deposit collection rates?

24:14
The financial aspect of a surgery often causes just as much anxiety for patients and their families as the the procedure itself does.

24:25
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.

24:34
It’s all extremely daunting and overwhelming for the average consumer.

24:40
So the key to this is providing patients with an accurate financial estimate as far out from their date of service as possible.

24:48
As soon as you have that scheduled case, an estimate should go out as soon as you possibly can.

24:53
You know, same day, 24 hours, however quickly you can get it out.

24:57
This allows the patients to plan better and prepare and it also enables them to trust you, which is the second key to this.

25:06
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 advance out as possible and then building that trust.

25:18
It’s really the trust that is key to all of this.

25:20
If they don’t trust the estimate that they receive and they don’t trust you, they are way less likely to pay.

25:26
So sending the estimate via text e-mail or discussing over the phone will allow you to build trust, collect more upfront payments, reduce last minute cancellations, and improve patient satisfaction scores.

25:40
And Speaking of patient satisfaction scores, questions related to finances and payments are often the lowest scores that AS CS receive and with OAS-CAHPS 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.

26:00
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 e-mail, and allow them to submit payment via credit card from the comfort of their home.

26:16
So that’s that third component that I had referred to earlier.

26:20
So for me, 3 tips to Improve Your Collection Rates.

26:24
Get that estimate out as soon as possible.

26:26
Build that trust with the patient as soon as possible and then allow them, you know, as soon as they receive 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.

26:40
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.

26:56
And hopefully you’re all already know this.

26:58
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.

27:06
This will not only increase patient deposit rates, but will foster trust, avoid surprise billing, and contribute to an overall positive experience.

27:14
You can get those satisfaction scores up, 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.

27:25
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.

27:33
And that officially wraps up this week’s podcast.

27:36
Thank you, as always for spending a few minutes of your week with us.

27:40
Make sure to subscribe or leave a review on whichever platform you’re listening from.

27:45
I hope you have a great day and we will see you again next week.