There’s a new executive taking a seat in hospital boardrooms across the country. Responding to Affordable Care Act (ACA) mandates that tie patient satisfaction to reimbursement, hospitals are recruiting chief experience officers (CXOs) to take charge of a patient experience mission that prioritizes the expectations of patients and families. While more CXOs are joining the C-suite, the best person for the role and the potential financial impact are still unclear.

Efforts to discharge happy patients aren’t new, but ACA requirements have fast-tracked patient satisfaction to the top of hospital priority lists.  According to the law, the Centers for Medicare & Medicaid Services must use Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data and other quality measures to calculate incentive-based payments for hospitals. Beginning in 2015, hospitals not meeting certain score criteria and other standards of care or complying with HCAHPS rules became subject to a Medicare reimbursement penalty of up to 1.5 percent. By 2017, that percentage will increase to 2 percent.

With the focus on satisfaction, an increasing number of U.S. healthcare facilities are appointing health executives, including CXOs, to take charge of developing and implementing strategies aimed at improving not only satisfaction, but the entire patient experience.

Titles and job descriptions vary by facility and are still evolving, but a 2015 survey of 1,000 healthcare facilities found that 63 percent of facilities have such an executive in place, according to Jason Wolf, PhD, president of The Beryl Institute, a Texas-based organization that researches the patient experience.

“[The emphasis on the patient experience] didn’t happen until the government mandated that we measure patient satisfaction … that we publicly report it, and … they tied reimbursement to it,” says Bridget Duffy, MD, who became the nation’s first CXO when the Cleveland Clinic appointed her to the role in 2009. Now the chief medical officer at Vocera, she founded Experience Innovation Network, an organization of CXOs across the country. 

Accountability & authority

While some say all hospital staff are responsible for patient satisfaction and question the need to hire a CXO, Duffy says it’s essential for hospitals to select an executive who has authority and accountability to make the patient experience a top strategic priority.

CXO duties may not currently be a full-time job, says Wolf, whose 2015 survey found that only about half of the hospitals that had assigned CXO responsibilities also made it an executive’s sole focus.

What’s crucial, he says, is that someone has the ability and the authority to “sell the patient experience to staff” and that he or she understands both the nature of healthcare and the organization’s financial structure.

While only 10 percent of The Beryl Institute survey respondents said a clinician needs to fill the CXO role, Duffy believe it’s a job best suited to a physician who works closely with a nurse.

“The real work around improving the patient experience will not happen in this country unless it’s linked to clinical innovation often driven by doctors,” Duffy says. 

The physician-nurse dyad is key, according to Hilary Nierenberg, RN, NP, MPH, administrator at New Jersey’s Hackensack University Medical Center Heart and Vascular Hospital. “Providing bedside care, … [nurses are] tuned in to look at very, very subtle differences or changes and can react to those needs, which is a big advantage,” she says.

Instead of adding a CXO or similar position to their staff, some hospitals have hired consultants to help them improve their patients’ experiences. This may translate into teaching customer service skills to hospital staff or assisting with data collection and interpretation.

Duffy says this type of support shouldn’t replace hiring a CXO. “Strategies for improving the patient experience should be of an organization’s own DNA,” she explains.

Impact & outcomes

“The patient experience focus is still so new, so it’s too early to tell what the financial impact is or the implications for outcomes. We’re doing more analysis of our data, but it seems clear that there’s no turning back from the patient experience,” Wolf says.

The potential for improving HCAHPS scores isn’t the only currency for measuring the value of naming a CXO or assigning oversight of patient experience to a hospital executive. Other measures are reflected in the HCAHPS questionnaire, which asks patients to rate communication with providers about medications, discharge instructions and other aspects of their care.

“The No. 1 gap is the breakdown in communication,” Duffy says. She adds that if there is a concerted effort to close that gap, patients may be more likely to adhere to prescribed treatments. In this way, championing the patient experience may impact reimbursement by reducing preventable readmissions. 

“[Satisfied] patients and family members … tend to look at the survey as a way of saying I can recommend this hospital. … . As recommendations go up, volumes go up and so do revenues,” says Darlene Cox, MS, RN, Hackensack University Medical Center’s administrator for service excellence.

Adding a CXO to hospital administration doesn’t have to be a burden because most facilities already have someone in charge of quality, satisfaction and safety, Duffy says, and the payoff can go beyond common metrics.

“The CXO’s job is not only to improve the patient and their family member experience, but also lead the strategy to create a culture that builds loyalty and engagement of the doctors, nurses and other front-line staff,” she says.

While the impact of this strategy on the bottom line may not yet be clear, Brian Carlson, MBA, director of patient access and experience at Vanderbilt University Medical Center, says efforts are paying off. “Scores are consistently getting better, so that means patients are rating [facilities] higher, which means that we are protecting the reputation of our institutions.”