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Patient Satisfaction Surveys: A Continuous NCODA Initiative for Improvement Within the Oncology Dispensing Practice
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Patient Satisfaction Surveys: A Continuous NCODA Initiative for Improvement Within the Oncology Dispensing Practice

Joshua J. Nubla, PharmD; Robert D. Orzechowski, MBA; and Aaron Budge, PharmD
NCODA presents findings from over 700 patient responses across the country to determine patient satisfaction over 4 categories: time, convenience, staff interaction, and overall satisfaction.
Patient satisfaction is an essential metric in the growing trend of value-based care within the oncology community. The National Community Oncology Dispensing Association (NCODA), in conjunction with Syracuse University’s Maxwell School of Citizenship and Public Affairs’ Community Link Program, has developed and distributed a patient satisfaction survey to its practice members. NCODA practices have held the high standard and goal of providing the best patient care to their respective communities, and surveys are one method by which NCODA has been able to provide its members a platform to display the benefits and value of their practice.

As of spring 2018, NCODA had collected over 700 patient responses from across the country, which were evaluated by Syracuse University’s Community Link Program. The satisfaction metric was separated into 4 core categories: time, convenience, staff interaction, and overall satisfaction. These data were subsequently stratified over multiple demographic groups for additional analysis such as gender, patient usage between mail order and in-office dispensing, financial assistance, and future patient use of dispensing. For NCODA practices, the overall satisfaction measured approximately 95% for patients who reported they were satisfied or very satisfied. From that subset, 92% reported being very satisfied overall. Moving forward, we aim to display this measure as an advance in value-based care within NCODA member practices. This aim is consistent with improvement of survey utilization and increased distribution. Reports such as these can be deemed beneficial for practices that are looking to exhibit and leverage these data to create a dialogue among various stakeholders for continued sustainability as well as to self-audit their own pursuit of excellence in oncology patient care.

Patient Satisfaction Surveys in the Medically Integrated Dispensing Practice: Issues and Observations

Data are a real and valuable commodity in most industries. We use data of all kinds, relevance, lot size, and accuracy as we try to proactively manage this historicly elusive wealth of information. Monetizing these data is quite another matter. In our business space, what specific data should we obtain, analyze, and operationalize?

Some say that improving the US healthcare system requires simultaneous pursuit of 3 aims: “improving the care experience, improving the health of populations, and reducing per capita costs of healthcare. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of a care provider organization that accepts responsibility for the 3 aims for that population. The healthcare organization’s role includes at least 5 components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.”2

When discussing patient satisfaction, 3 fundamental questions emerge: “Is it worth measuring? How can it best be measured? How are we to use the results? These 3 questions—1 philosophical, 1 empirical, and 1 practical—form a framework for evaluating the place of patient satisfaction within the patient outcomes movement.”3​​​​​​

Patient satisfaction can carry strategic weight beyond the traditional objectives of other patient surveys for medically integrated dispensing (MID) practices. Under current circumstances, would it be more appropriate to address the patients as “consumers”? Today, patients are guided to see themselves as buyers of health services. “Once this concept is accepted, there is a need to recognize that every patient has certain rights, which puts emphasis on the delivery of quality healthcare.”4

Private MID practices are at the intersection of healthcare, technology, and human service We all have data dashboards, laws, regulations, and policies to guide our decisions on every aspect of the business. These data are usually timely and valid, and we can reasonably rely on them. What we do not have are data that are just as valid and reliable to help us better manage the business with the goal of an optimal, at least a favorable, patient experience.

Patient satisfaction surveys have evolved into a full-fledged data set and platform. From large health systems to the smallest private medical practice, obtaining, analyzing and responding (or not) to results can certainly provide benefits. They can also serve as a management tool to better align management’s goals, marketing messages, and process design based upon survey results. The practice of medicine has evolved over centuries. There are certain significant developments that have taken place in health systems in recent times, chief among them being:
  1. Establishment of high-cost corporate-style hospital systems equipped with the latest facilities.
  2. Strategic integration of third-party payers, insurance companies, specialty pharmacies (SPs), pharmacy benefit managers (PBMs), government entities, distributors, and companies on the periphery of the doctor–patient relationship.
  3. Availability of information through the internet, and higher expectations of patient care.5
  4. Increasing litigation methods from delay in diagnosis to breakdowns in communication6 and other consequences of unsatisfactory results such as financial distress/toxicity.7
All of these factors have resulted in a challenging environment for the healthcare industry, with a movement away from the traditional concept of a noble profession toward more of a service industry.

In a major report published in 2001, the Institute of Medicine, now the National Academy of Medicine, set forth 6 aims for quality and patient safety in a healthcare system1:
  1. Safe
  2. Equitable
  3. Evidence-based
  4. Timely
  5. Efficient
  6. Patient-centered
Factors 4 through 6 directly influence patient satisfaction.

The NCODA Patient Satisfaction Survey

The NCODA Patient Satisfaction Survey was developed in conjunction with Syracuse University in 2016 with the purpose of measuring qualitative differences within the pharmacy-dispensing space. NCODA created a template that allows practices to add their own brand details that could be sent to a central location for aggregation. The Community Link Program has a process where the data can be coded and accounted for future analysis, which

is then presented to the membership in multiple channels such as at national conferences and webinars. Practices utilizing the surveys have the ability to account for areas of high satisfaction and possible improvement, which is paramount to the NCODA foundation and quality standards. The goal of the surveys is to create a quantitative narrative based on the positive influence that MID practices can provide by virtue of being at the cross-section of clinical and operational responsibilties. NCODA members strive to focus on creating better quality interventions within the continuity of care for the patient, and the surveys allow for that collective voice to be heard.

The MID Patient as a Consumer

Patients with cancer, as a population within the healthcare environment, present with certain issues and characteristics that can be well managed in the MID space, and at an overall lower cost than what is found in larger systems. Further exacerbating the higher costs and challenges to timeliness and quality of care are the payer/SP/PBM demands and constraints placed upon the MID practice. However, these issues are outside the scope of this article to develop more fully.

The NCODA survey is meant primarily as a tool to prove to legislators, regulators, insurance companies, SPs, PBMs, employers, and patients that the MID practice has real value in the cancer care continuum. The survey is intentionally brief. Most MID practices conduct other patient surveys besides the in-office dispensing (IOD) service line. Numerous surveys are available to obtain a picture of satisfaction and other metrics across all organizational aspects. The NCODA survey is given exclusively to IOD patients, usually at their second visit, the reason being that at the first visit, patients are bombarded with information about treatment decisions, drug interactions, studies, imaging, and other ancillary services. Survey fatigue can be a real issue for patients with cancer, over half of whom are over age 65 and suffer from comorbidities. Also, for MID practices that are in the Oncology Care Model or other government advanced payment models, those patients receive lengthy surveys already. The MID practice must be sensitive to this reality.

The NCODA Patient Satisfaction Survey is straightforward and easy to complete. No personally identifiable information, such as name, address, or social security number—is collected. The 1-page survey mainly includes check-box questions, and the hard copy surveys are collected, scanned, and sent to NCODA headquarters for coding and accounting. Summaries are available for either the individual practice submitting the data or the NCODA-wide summary data. When evaluating the data, NCODA believes that service excellence revolves around 3 factors: doctor, patient, and a medically integrated organization.

The Medical Oncologist/Hematologist

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