Affinity Program Spotlight: Building Home Health Referrals Using Patient Satisfaction

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The days of passively expecting a reliable flow of new patients from referring physicians and discharge planners is long over. Home health agencies need to proactively incorporate quantified results that promote their unique position in the care continuum. Successful agency leaders align their agency to continuously deliver care that will be perceived in a positive manner by patients, driving word of mouth recommendations. Increasing both the quantity and quality of patient referrals using high patient satisfaction scores is an effective strategy for growth. Using the results from the Home Health CAHPS® survey, particularly the overall recommendation measure, will identify opportunities for care improvement helping agency leaders focus resources more effectively.

Focusing on the recommendation rating is a key component for improving referrals. In a recent study by Nielsen, 90% of consumers said they trust recommendations from family and friends above all other forms of advertising1. Thus word of mouth advertising can have a substantial impact on building market share in the community, sustaining patient volume and increasing revenue. The question is how much time and effort and what types of activities should be allocated to improving patient satisfaction? Considering the power of recommendations, it follows that allocating more resources to improving patient satisfaction scores can deliver many positive benefits, including higher profitability via increased referrals. In addition, because unsatisfied patients are more than twice as likely to share their negative experience with ten or more persons3, it is clear that any actions that can decrease satisfaction are important opportunities for improvement in processes, procedures and training.

spot_color_onwhiteNow that HHCAHPS scores are publically reported on Home Health Compare, physicians, discharge staff, nurses, patients and other influencers can easily discover how satisfied patients are with a specific agency. The recommendation question on the HHCAHPS survey can be your best resource for discovering what types of problems are hindering your ability to gain positive recommendations.

A low score on the recommendation measure is an indication the agency is not providing adequate care from the patent’s perspective. Whether the agency is or is not providing appropriate care may not matter. The patient’s perception of care is their reality, and it is their reality which is reflected in HHCAHPS scores. Negative perceptions of care by the patient are often shared with the patient’s physicians during visits and calls. No physician would want their patients in non-optimal settings, since such actions may also have a negative effect on their relationships. Repeated negative patient care experiences will deter future referrals from that physician.

A best practice from the 2012 HHCAHPS Honors for increasing referrals is to maintain a higher recommendation rating than directly competing agencies. Analysis of the HHCAHPS data on Home Health Compare shows that 71% of providers have a Recommendation score lower than 85%4. Agency performance at or above this benchmark will likely create stronger relationships with referring and recommending entities. There are thousands of home health agencies that have scores below this benchmark indicating there is significant opportunity for agencies with high recommendation ratings to increase their share of patients.

A low recommendation rating on Home Health Compare is a considerable disadvantage, but improving the score does not have to be an overly complicated process. It does take a focused, committed effort using data-driven analytics to pinpoint where the main drivers for improvement lie, combined with an ongoing management plan. The national data from the HHCAHPS survey reveal there are several persistent negative patient perception issues industry-wide. These negative perception issues are related to dissatisfaction with either the agency staff or with agency procedures. Agency leaders need to discover the root causes driving these negative perceptions and create targeted refinements for each improvement opportunity. Emphasis on improving the perception of care establishes a foundation for an agency culture that sustains high scores on patient satisfaction surveys, including the Recommendation rating.

Dedication to providing great customer service is one of the most important factors when building a culture that nurtures satisfied patients. There are hundreds of definitions, interpretations and business models regarding the concept of customer service. One commonly shared interpretation is “to provide care exceeding the level which the patient expects.” In this simple definition of customer service there is unexpected complexity and there is also great opportunity. The concept of “expectation” is different for every patient and family. Further, the concept of “expectation” and the effort needed to exceed that level is most likely different for every staff member. Bridging the gap between understanding the expectations of the patient and aligning the agency’s ability to continuously deliver above and beyond those expectations is what sustains a high level of satisfied patients.

One solution is looking at other industries for ideas to embrace. Some of the most successful restaurants and retail stores have been able to differentiate themselves on the level of customer service provided. An example of client-centered service is with retailers who, if you need help finding a specific department, the staff does not point or give directions; instead they personally walk you to the correct place in the store and find a colleague specialist in the department to assist. Great service can be supported through many types of positive interaction. Another example comes from the training and approach from a major theme park company. At these theme parks, when staff is asked a question such as “what time does the park close for the night,” the staff is taught to respond that the parks “will be open until 10PM” rather than “we close in two hours”. This is a simple but positive change in the wording of the response. A simple adjustment in language makes a huge impact on the relationship developed and expectations set with the customers.

Home health providers should embrace new ways of delivering outstanding customer service as a core operating approach. The effort needs to concentrate on building strong supportive relationships between the agency and patient, physician and other influencers such as family members. Positive, above-expectation interactions with the agency staff builds a foundation of confidence in the patients’ perception of their care. Continuous high-level delivery fosters positive interactions about their experience with physicians, family members and friends. This is an ongoing process that evolves during the relationship with the patient. To raise satisfaction levels, agencies must actively set, evaluate and deliver on patient expectations during all care and service interactions. For example, the expectation established during intake, or before discharge, may be that the agency staff will always be prepared and understand the care plan at every visit. If just one member of the team is not completely prepared to care for a patient before they enter the home, the patient will feel frustrated and confidence in the clinician and the agency begins to diminish. If this scenario happens repeatedly, the patient becomes dissatisfied with the agency because their expectations have not been met and will likely give the agency a low score on the HHCAHPS survey. A proactive approach putting the needs and expectations of the patient at the center of relationship will create and maintain a positive perception of care and service. Sustaining this level of interaction is the catalyst for patients offering positive recommendations – fueling referrals to physicians, influencers and friends in the community.

The patient’s perception of their care is their reality. No matter how well the agency believes they are performing, being empathetic to the patient’s point of view is essential, and its impact can have powerful effects on the agency. It is important to align processes, procedures and training to create care delivery that results in satisfied patients. Using HHCAHPS data to pinpoint where and how to best concentrate agency resources simplifies this effort. By enhancing care and service protocols, the relationships between the clinician, the patient and the agency all improve. And it is through these trusted relationships that a patient’s confidence increases, leading to better agency recommendations. The impact of this result is far too great to ignore for agencies wishing to increase referrals and achieve higher, sustainable growth.


  1. Nielsen Global Trust in Advertising and Brand Messages. April 2012
  2. Aligning Forces for Quality 2010. Good for Health, Good for Business: The Case for MeasuringPatient Experience of Care, 1-7. Princeton, NJ: Robert Wood Johnson Foundation. Hall, M.F. 2008. “Looking to Improve Financial Results? Start by Listening to Patients.” Healthcare Financial Management Association, October 2008
  3. Chase R.B., and S. Dasu. 2001. “Want to Perfect Your Company’s Service? Use Behavioral Science” Harvard Business Review 79 (6): 78-84
  4. Home Health Compare Data Analysis. Deyta. January 2013

About the Author

Bill Bassett is the Vice President of Home Health for Deyta, LLC, the leading provider of HHCAHPS Survey administration, business intelligence and quality measurement for hospice and home health. Bill provides oversight to all home health operations and works strategically with large, national home health providers to create easy-to-understand solutions that improve the quality of care for home health and hospice organizations. His experience spans over 20 years of success in healthcare, analytics, business intelligence, and technology organizations including Deyta, OCS, and Bristol-Myers Squibb.

Bassett is the foremost “Patient Perception Coach” in post-acute healthcare working with providers to translate satisfaction data into usable insights. From these insights he applies best practice techniques creating easy-to-understand solutions that improve the quality of care, strengthen operations and increase referrals for the provider community.

A few of his accomplishments include developing the industry’s first integrated analysis of satisfaction, quality and financial measures, developing predicative modeling tools to help identify re-hospitalizations before they happen, and creating the HHCAHPS Honors®, the HomeCare Elite® and the Hospice Leaders Forum to recognize forward-thinking agencies in post-acute care.

About Deyta

Partnering with thousands of hospice, home health, human services, and other healthcare organizations, Deyta simplifies data driven management, enabling our clients to overcome the avalanche of information that clouds good judgment. With Deyta, healthcare leaders make proactive decisions that strengthen financial performance, improve operational efficiency, assure CMS compliance, and provide better patient care.

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