Differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey Scores by Recency of the Last Visit: Implications for Comparability of Periodic and Continuous Sampling.

BACKGROUND: Patient experience data can be collected by sampling patients periodically (eg, patients with any visits over a 1-year period) or sampling visits continuously (eg, sampling any visit in a monthly interval). Continuous sampling likely yields a sample with more frequent and more recent visits, possibly affecting the comparability of data collected under the 2 approaches. OBJECTIVE: To explore differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey (CG-CAHPS) scores using periodic and continuous sampling. RESEARCH DESIGN: We use observational data to estimate case-mix-adjusted differences in patient experience scores under 12-month periodic sampling and simulated continuous sampling. SUBJECTS: A total of 29,254 adult patients responding to the CG-CAHPS survey regarding visits in the past 12 months to any of 480 physicians, 2007-2009. MEASURES: Overall doctor rating and 4 CG-CAHPS composite measures of patient experience: doctor communication, access to care, care coordination, and office staff. RESULTS: Compared with 12-month periodic sampling, simulated continuous sampling yielded patients with more recent visits (by definition), more frequent visits (92% of patients with 2+ visits, compared with 76%), and more positive case-mix-adjusted CAHPS scores (2-3 percentage points higher). CONCLUSIONS: Patients with more frequent visits reported markedly higher CG-CAHPS scores, but this causes only small to moderate changes in adjusted physician-level scores between 12-month periodic and continuous sampling schemes. Caution should be exercised in trending or comparing scores collected through different schemes.

Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service.

OBJECTIVE: To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). DATA SOURCES: Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. STUDY DESIGN: Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). PRINCIPAL FINDINGS: Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. CONCLUSIONS: Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment.