Enhancing the virtual experience at the Cleveland Clinic

As our healthcare system transitions to value-based care, patient satisfaction is no longer an afterthought.

In 2009, the Cleveland Clinic became the first major U.S. academic medical center to create the board-level position of Chief Experience Officer (CXO). Since then, many other leading hospitals have followed suit. In a recent Vocera study, 64% of the CXOs surveyed are direct peers of quality/safety and performance improvement leaders.

The main vehicles for assessing patient experience and satisfaction are the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys established by the Agency for Healthcare Research and Quality. They’re sent to a statistically significant portion (but not all) of the patients treated.

The Cleveland Clinic publishes its HCAHPS scores and recent performance metrics on its website for the world to see. Its affiliated clinicians and practices also publicly share the results of CAHPS Clinician and Group (CG-CAHPS) patient surveys.

Dr. Peter Rasmussen knows a lot about both surveys. His wife, Dr. Adrienne Boissy, is the Cleveland Clinic’s CXO – and Rasmussen is the former director of the Clinic’s Cerebrovascular Center and current medical director of its Distance Health program. The Center conducts about 1,300 telestroke consultations per year, while Distance Health offers 1,400 scheduled telehealth visits each month.

This year, Dr. Rasmussen has been a featured speaker at both the Cleveland Clinic’s Empathy + Innovation Summit and InTouch Health’s Telehealth Innovation Forum in Santa Barbara, California. His message at both events was encouraging: patient satisfaction scores for telehealth encounters often exceed those for in-person visits.

“A telestroke patient would be more likely to receive an HCAHPS patient satisfaction survey that spans the entire hospitalization,” says Rasmussen. “Some of our ambulatory patients who are treated virtually receive the CG-CAHPS survey.”

Rasmussen says that Distance Health’s largest population of patients – those who receive virtual visits for on-demand urgent care – have average satisfaction scores of 85%, compared to the 75% average scores of those seen at brick-and-mortar facilities.

Measuring patient satisfaction

The CAHPS surveys currently measure things like provider empathy, clarity of communication and care coordination. “These all involve talking, and can be done just as well virtually as in person,” says Rasmussen. “There’s really no difference when it comes to interpreting lab work and creating management plans. If you’re already skilled in empathy and clear communication in person, it translates well to a virtual visit.”

Rasmussen adds that patients seen virtually are usually quite pleased with the care. “In my experience, patients who are comfortable with virtual visits don’t have any complaints,” he says. “Obviously, you can’t have that interaction with every patient. But those that are amenable to the technology feel that it’s a fantastic way to interact with providers.”

The CAHPS surveys currently don’t measure the timeliness of care or the effective use of technology – but Rasmussen can foresee a time when they become important metrics in patient experience. “In contrast with in-person visits, telehealth patients expect you to be on time,” he says. “In the office setting, I might be running 15 or 20 minutes behind and patients accept that. But with virtual visits, if it’s scheduled for 2 p.m., the patient expects me to be punctual.”

It’s hard to imagine telestroke patients giving less than a perfect 10 satisfaction score to a provider that saves their lives – and that’s exactly what the Cleveland Clinic’s mobile stroke treatment unit does throughout the year. Nationwide, less than 4% of stroke patients receive the clot-busting tissue plasminogen activator (tPA) within three hours of onset. But the Clinic’s mobile stroke unit has now elevated that number to an exceptional 31%. The results: fewer stroke-related deaths and long-term disabilities.

Early adopters play key role

“Telehealth technology is helping deliver the value and efficiency that we’re striving for in the healthcare system,” says Rasmussen. “Asynchronous interactions with patients and remote patient monitoring, both active and passive, will soon be commonplace. Clinicians need to get on board today because it’s going to transform medicine in the very near future.”

Yet most physicians, even at the renowned Cleveland Clinic, are still not embracing telehealth with gusto. “At the Clinic, about 15% of our clinicians have been enthusiastic early adopters of telehealth technology – and we’re hoping they’ll help convince the skeptics,” says Rasmussen. “The main hurdle, as in any industry, is reluctance to change. A physician may have a full panel of patients in the office, and the status quo is working well. To take a different path means that there might not be any cheese at the end of that path, or maybe a saber-tooth tiger might eat you along the way.”

That attitude may change rapidly as more patients demand the flexibility of virtual visits. The Cleveland Clinic’s guiding principle is “patients first” – and it’s committed to providing the finest patient-centric care, both virtually and in person.