This popular TV show of the 1960s, Candid Camera, was possibly the first reality show set up to catch people doing unusual things on TV without knowing it. A hidden camera sometimes observed people doing ordinary and potentially strange things unaware that they were being watched. Everyone enjoyed their reaction to themselves when told to “Smile, you’re on candid camera!” CMS-directed anonymous Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are the “hidden camera” of health care.
This survey is important because CMS has designated it to make up eight of the thirty-one consolidated metrics that measure physician performance in the Accountable Care Organizations (ACO). The hidden camera is the anonymous eye of the patients that receive care from a specific provider.
The focus of the survey is on the patient’s experience and not just satisfaction. So, communication, understanding medication instructions, and the availability of an appointment become important measures. The surveys do not focus on the color of the carpets or wall coverings in the office.
Health care is a personal matter; therefore, the trust and confidence patients have in their doctors does make a difference. This intangible metric often makes the difference between a patient taking a prescription drug and not taking the treatment. Likewise, no one wants to call a grumpy doctor to ask a question on a Friday afternoon that might otherwise bring them to the emergency room, when an office visit would have brought resolution. Most folks have enough self respect to avoid the rude and gruff office staff which could potentially lead to an unanswered yet important medication question. This is why CMS measures the experience that patients receive rather than knowing that there is a grand piano in the lobby.
CAHPS surveys may only be administered by certified providers who administer a tool that follows scientific principles in design and development. Additionally, all surveys use standardized questions and collection protocols. The survey tool only emphasizes the importance of the art of medicine as providers deliver the science.
Hippocrates (ca. 460 BC – ca. 370 BC) noted that “wherever the art of medicine is loved, there is also love of humanity.” This learned observation is relevant for today as the ACO leadership wrestles with the annual wellness visit or continuous attribution of their beneficiaries. In today’s world of radical change in health care, where the business of medicine could dominate our thinking and practice, the CMS CAHPS survey can remind us that teaching and caring may be just the “glue” we need to hold the system together. SMILE!