Hello, everybody, and welcome. This is our second edition of CAHPS Insider Live, and we have some great stuff for you today. I'm excited you can join us. My name is Matthew. I will be your host today, and I will be in the background trying to help you out with whatever you need. Before we get started, let me just walk you through the platform a little bit. Up in your right, we have the chat. You're welcome to share your thoughts and reactions there. Why don't we start off by just sharing the best thing you did this summer or where you're joining us from? Now, below the chat on the right side is the Q&A box. This is where you can ask a question directly to our presenters. Any of those questions we don't get today, we'll do our best to follow up with you offline. In the bottom left, you have some related resources you might find helpful, like today's slides and the August CAHPS Insider, and up in the top left, you'll find bios for today's presenters, Kylie and Jeff. As always, a link to this recording will be sent out within two business days. That's more than enough from me. Let's go ahead and dive in. Kylie, can you take us away? Great. Thank you so much, Matthew. I appreciate that. Hello, and welcome, everyone. My name is Kylie Hasenauer, and I serve as the corporate compliance officer at NRC Health. Thank you all for joining us today and taking some time out of your day to learn more about the CAHPS updates coming. 2025 is quickly approaching us, and we have many updates taking place within our CAHPS surveys that we'd like to talk about and discuss more with you today. Today, we'll be talking about the updates coming with the CAHPS Hospice Survey, then we'll be talking about HCAHPS updates. As Matthew mentioned, Jeff Gill is with us here today to talk more about the Value-Based Purchasing Program and the updates coming there as a result of the HCAHPS survey changes. Jeff is our customer success advisor at NRC Health, so we appreciate him being with us. At the end, we have a few next steps, and then we'll have a few minutes for some questions and answers as time allows. All right, so first, to talk about CAHPS Hospice Survey updates. At the end of July, the final rule was released for fiscal year 2025, which impacts many updates to our CAHPS Hospice Surveys. There will be some changes coming beginning with April 2025 decedents, and that includes survey updates resulting in a new 39-question survey. Currently, the CAHPS Hospice Survey is 47 questions. Some questions will be removed and others added, resulting in a new 39-question survey. The data collection period is extending from 42 to 49 days, so this means caregivers will have an extra week to complete the CAHPS Hospice Survey. Mail-only methodology will be used as the reference mode for adjustments. Currently, the mode being used is telephone only, so that will be updated beginning with April decedents to be mail only. A pre-notification letter will be mailed prior to survey administration, and a web/ mail mode will be available in a CMS-approved methodology. I did, however, want to mention that at this time, NRC Health is very focused on making all of the mandatory updates to the CAHPS Hospice Survey, as well as all of the changes coming to the HCAHPS surveys. So at this time, for April 2025 decedents, NRC will not be offering the web/ mail methodology. However, this may be something that we continue to keep an eye on and perhaps pursue in the future. All of these changes were part of the proposed rule that was released earlier this year. However, it was proposed that all of these changes would take place beginning with January 2025 decedents. The changes are finalized, but finalized with April 2025 decedents, so they're giving us an extra quarter to make all of these changes, so we did want to point out that difference there. The way that the CAHPS Hospice Surveys work, there's a bit of a delay, so April 2025 decedents will not actually mail until the beginning of July. So we will continue using the existing version of the CAHPS Hospice Survey and sending those out, and then beginning with April 2025, decedents mailed in July, we will have the new updated questions. So as I mentioned, there are several question changes to the hospice survey. So they're removing 12 of the current questions that are on the survey today and adding four new questions. They have also made several updates to existing questions, so changing a word out for something else, maybe deleting a word, very minor changes. We do have a detailed outline of all of the survey changes taking place, and that was sent out with the notification of the final rule and also included in the August edition of the CAHPS Insider newsletter, so you can always find that information there. Next month, our compliance team will be attending the update training for CAHPS Hospice Surveys, so at that time, we anticipate we'll have a lot more additional information for you coming after we attend that training. Aside from that, we do want to assure you that NRC is making all of these changes on your behalf to our survey management system and making sure that we follow protocol, so there are no changes needed at this time from you. And next, we'll dive into HCAHPS changes. So as you're all aware, there's a lot happening with HCAHPS, beginning with January 2025 discharges. We wanted to reiterate some of the points that we had talked about recently in our last Insider Live, as well as address some of the questions that we have gotten in the last couple of months. So some of the items finalized in the fiscal year 2024 inpatient rule included the addition of three new web-first methodologies: web/mail, web/phone, and web/mail/phone. We've gotten some questions on the outreach schedule and what that looks like specifically for patients when they do not have an email address. Here's the outreach schedule for those three new web-first methodologies. We wanted to talk a little bit more in detail about what that would look like. For example, let's say that your hospital is doing the web/mail methodology. You'll send NRC your data file. We complete the sample on your behalf and sample patients for HCAHPS. If patients were sampled for HCAHPS, but they did not have an email address in the data file that we received from you, they would not receive their HCAHPS outreach until that first mail survey went out on day eight. The second mail survey would be mailed out on day 30, and then data collection would end on day 49. Again, no HCAHPS outreach until they would receive that first mail survey if they do not have an email address in the data file. Similarly, for web/phone outreach, we would do the email outreach for all patients sampled for HCAHPS if they had an email address. If they did not have an email address, we would begin their phone call follow-up on day 10, and then ending data collection on day 49. Some of the questions we've received are: For those patients that do not have an email address, can we move up the outreach schedule? Unfortunately, the answer there is no. This is all CMS protocol. We attended the update training a few months ago, and CMS and the HCAHPS Project Team were very clear that we cannot change the outreach schedule at all, and we must adhere to these guidelines. Again, I think this reiterates the importance for capturing the email addresses for all of your patients at time of admission and making sure that it's a valid email address that can be used for your HCAHPS surveys, and some of the other items that were finalized last year include the supplemental question limit of 12 questions. The comment box is a supplemental question already, so keep that in mind as you're making your decisions. We're required to collect patients' preferred language because we must fill the HCAHPS survey in Spanish if the patient identifies as preferring the Spanish language. If your customer success team has been in touch regarding Spanish updates that are needed to your data file, please ensure that you are taking next steps to begin sending NRC the language information, as this is a requirement starting next year. The data collection period is extending from 42 to 49 days, so this means patients will have an extra week to complete the HCAHPS survey. Proxy respondents will now be allowed to complete the survey, and IVR is being removed as a survey administration mode. IVR is actually not a mode that is currently used, so they're removing that and then adding on the three new web-first methodologies. Then at the beginning of August, the inpatient final rule was released for fiscal year 2025, and that finalized all of the proposed changes that we had seen in the proposed rule earlier this year. We wanted to highlight those for you today also. We have finalized survey updates, resulting in a 32-question survey. Currently, the HCAHPS survey is 29 questions. Because of the many changes to the HCAHPS survey questions, that impacts our HCAHPS dimensions, which also impacts what is publicly reported in the Value-Based Purchasing Program. They've also finalized a new planned stay patient mix adjustment. The communication for the final rule was sent out on August 5th, and that information was also included in the August edition of the CAHPS Insider newsletter if you would like to reference that. So for our question changes for the HCAHPS survey, the HCAHPS survey is currently 29 questions. They're removing five questions and adding eight new questions, resulting in a 32-question survey. The last question on this slide, "Was this hospital stay planned in advance?" is the question that will be making up the new patient mix adjuster. And again, because there are so many question changes, that impacts what we see for public reporting. So currently, there are 10 sub-measures reported from the current HCAHPS survey. Beginning with the January 2026 refresh, they will only be reporting on the eight unchanged sub-measures from the current HCAHPS survey, then in October 2026 refresh, there will be 11 sub-measures reported from the updated HCAHPS survey. So again, it's important to remember that during that overlap period, where some quarters were using the old or current version of the HCAHPS survey and some quarters were using the updated HCAHPS survey, they'll only be reporting on those eight unchanged sub-measures. And here are those sub-measures laid out for you, so again, we have 10 that are currently reported. Care Transitions and Responsiveness of Hospital Staff will drop off from that January to July 2026 refresh period, where only the eight unchanged sub-measures are reported. And then starting with October 2026 and moving forward, you'll see the Care Coordination, Responsiveness of Hospital Staff, and Information About Symptoms. Sub- measures all rolled on and beginning public reporting with that October refresh. Again, these were all changes that were part of the proposed rule, but just recently finalized, so we wanted to highlight all of these for you again today. All right, and at this time, I am going to turn it over to Jeff Gill to talk more about updates to the Value-Based Purchasing Program. Thanks, Kylie. Lots of great information there. Lots of changes coming. I'm going to talk about the Value-Based Purchasing Program a little bit, and how these changes that Kylie just described are going to impact the program that ties to your Medicare reimbursement. First piece that I want to talk about is revisiting, although this is just a slightly different view than what Kylie talked about, and it's looking at each of the different dimensions that make up the Value-Based Purchasing Program currently in the upcoming year, and then beginning in fiscal year 2030, the changes. So the first piece that I want to call out here, as Kylie mentioned before, Care Transitions and Responsiveness are both going to be removed from the current HCAHPS survey. These dimensions are no longer going to be included beginning in January at the start of fiscal year 2027. It is worth noting that Care Transitions is going to be removed permanently with this change. Then, beginning in fiscal year 2030, we are going to be adding in some additional dimensions into the mix. Responsiveness of Hospital Staff, Care Coordination, and Restfulness of the Hospital Environment are going to be updated and added to the fiscal year 2030 program year. Currently, Responsiveness of Hospital Staff includes the call button question, which is being removed, and that is why this particular dimension is not going to be reported during the overlap period between fiscal year 2027 and fiscal year 2029. So we've talked a lot about changes that are coming. I want to shift gears a little bit and talk about what remains the same, sort of. as well as the changes that are on the horizon for the Person and Community Engagement component of the Hospital Value-Based Purchasing Program. That's the HCAHPS survey piece. The first piece of this is that the Hospital VBP Program is, and has been, a budget-neutral program funded by reducing participating hospitals' base operating DRG payments each fiscal year by 2%, and then redistributing the entire amount back to the hospitals as a value-based incentive payment. This program is going to continue to operate in a budget-neutral way, and the amount being withheld from each individual CCN is going to remain at 2% during this transitional time period and beyond at this point. Scoring is also going to be consistent with what we've come to know in the past around the Value-Based Purchasing Program. There has been, and there will still be, a maximum of 100 points earned across each of the different dimensions that are reported. You can earn a maximum of 80 points for improvement or achievement, so how are you performing on each of those domains? And then there's still going to be 20 points based on consistency, so looking across all of them and how well you're performing on your lowest scoring dimension, is going to impact that last 20 points. For improvement and achievement, each dimension is weighted equally, and you will earn the greater of the two. This is also consistent with how it's worked in the past. The big difference here is that as we move from eight dimensions to six dimensions to nine dimensions, each of those dimensions will be weighted slightly more in the years 2027 to 2029, and a little bit less once we hit fiscal year 2030. As a reminder, improvement maxes out at nine points based on your improved score above the baseline period. Achievement is earned based on if you are above the 50th percentile, and quite honestly, it's how far above the 50th percentile your score falls, up to a maximum of 10 points. So they reward high performance, but they also want to recognize the efforts that are occurring each and every day within your organization from an improvement standpoint. For our consistency piece, there is a maximum of 20 points based upon the comparison of your lowest dimensions performance compared to the floor minimum of that dimension. Note that, in 2027, the pre-normalized HCAHPS base score will be multiplied by eight divided by six, or 1.33 points. Again, I mentioned before, each of them will be weighted a little bit more because there are fewer dimensions, and then rounded according to standard rules, meaning that if it is a score of 0.5 or higher, it's rounded up, below 0.5 are rounded down, to create the normalized HCAHPS base score.... beginning in fiscal year 2030, the pre-normalized HCAHPS base score would then be multiplied in, if you calculate it, eight divided by nine, or about 0.89 points each, and then rounded again according to those standard, rounding rules. So for the most part here, you are seeing a lot of changes with the dimensions, the questions on the survey, but how it's calculated remains overwhelmingly consistent. Just the weight during that time period of going to six dimensions and nine dimensions will change a little bit for that. So at this point, I will turn it back over to Kylie to talk about next steps. Great. Thank you so much, Jeff, and thanks for being here to help provide some of that clarity and some answers for our partners today. All right, so yes, we have some next steps before we wrap it up here. Please continue to work with your customer success manager or your project specialist and keep them updated on if you are interested in one of the new web methodologies for January 2025 discharges. Your customer success manager will be partnering with you closely in the next few weeks and months to help ensure that you are prepared strategically for all of the question changes coming and what that means for your organization. We're requesting all decisions for HCAHPS 2025 by October 1st. Beyond this, we also want to mention that NRC is working continuously behind the scenes, updating our survey management system and getting all protocol in place to ensure that you remain in compliance going into 2025. We know that many of you have already implemented your ASCs, but as a reminder, we wanted to mention that OAS CAHPS is a link to reimbursement beginning with January 2025 for ASCs, for our ambulatory surgery centers, so this last January 2024, it was linked reimbursement for hospital outpatient departments. Beginning now, in a few months, January 2025, it will be linked to reimbursement for ASCs. If you have any questions there or concerns, please reach out to your customer success team, and NRC has several, what we call point-in-time surveys. So these are CAHPS surveys that field once, maybe two times a year, opposed to our ongoing surveys that we're used to. So our point-in-time surveys include ICH CAHPS, ACO REACH CAHPS, PCF PECS CAHPS, and CAHPS for MIPS. All of those point-in-time surveys actually field during the fall, so it's a very busy time for us. Please be on the lookout for communication from our compliance team as we progress through the fielding period if you have any practices, clinics, centers, doing any of these CAHPS surveys, as we will send out communication once we are into the fielding period for each of those. And also, as a last reminder, the authorization deadline for CAHPS for MIPS is next week on September 11th. So if you have not authorized a survey vendor yet, please be sure to do so by that deadline. All right, and at this time, we have a few more minutes for some questions and answers. Yeah. Thank you, guys. That was a lot of good information. We appreciate it. We have been getting quite a few questions coming in. Let's start here: If a mailed survey is sent to a patient, the patient waits a long time before returning the survey, and then before the survey is received, the patient completes the phone survey, which survey would count? So the survey that would count would be the first survey that was received. Previously, with mail only, there were two waves, which meant we would have to wait 84 days to consider a period closed out. With the data collection period being extended to 49 days, does that mean we have to wait 98 days to consider a period closed? So it's based on how quickly the surveys. We can sample your data file and then get the survey sent out. Once the survey is mailed or we begin survey administration, rather than waiting 42 days for surveys to expire, we'll be waiting 49 days for expiring. So again, it's more so based on time of discharge and when NRC sends out the HCAHPS survey. And then from there, from the time that HCAHPS data collection starts, then it's 49 days from that period. Great. We have another one here: Do the 32 questions include supplemental, or is it 32 standard plus the 12 supplemental? The 32 questions do not include supplemental. We have the 32 core HCAHPS survey questions, and then you would get up to 12 supplemental questions on top of that. I see, maybe somebody was clicking our CAHPS Insider in the Resources section. This question says, "Where can I find CAHPS Insider newsletters? Yes, good question. Let's go over that, so if you go to the NRC Health website, nrchealth.com, at the top, you will see an option that says Resources. If you click on that, you'll see lots of resources available to you: newsletters, podcasts, a lot of great information there. All of our CAHPS Insider newsletters are saved there on that page. You can also filter just to CAHPS. If you see on the right side, there's an option where you can click on CAHPS, and all of the CAHPS Insider newsletters are saved there, and those are published monthly, so those can be accessed at any time. Yeah, and I will add that, we also send those out in our monthly newsletter, or I'm sorry, our weekly newsletters. The CAHPS Insider is sent monthly, of course. So if you scroll down to the bottom of that resources page, there's a section that you can sign up for the newsletter, and you'll be sure to get sent those anytime, as well as updates on our other content, events, and things like that. Let's see. Do I need to send additional data to collect proxy information? No. So I do see we've gotten a few questions about proxy and how that will work. So patients will still receive the HCAHPS survey just like they do today. It's still preferred that the patient is the one who is completing the HCAHPS survey. However, if the patient's not available and a proxy would like to complete the HCAHPS survey on the patient's behalf, then those proxy responses will be captured and submitted with January 2025 discharges. So currently, if we receive a proxy response, those responses are not used, they're not submitted. And so beginning in January, if it's determined that a survey was completed for HCAHPS via a proxy response, those responses will still be counted and used. Great. Can inpatient real-time surveys still be administered after HCAHPS sample has been picked? I'm sorry, can you repeat the question, Matthew? Yeah, I'm sorry. Yeah. Can the inpatient real-time survey still be administered after the HCAHPS sample has been picked? Yes. HCAHPS must still be the first sample, and then after that, any additional samples would be completed after the HCAHPS sample has been conducted. Somebody here is asking just for a little bit of clarification, "Where you said October 2025 refresh, do you mean the CMS data collection period of January through December 2024?" So- So- Go ahead, Kylie ... the new 11 sub-measures will be reported beginning with October 2026 refresh and moving forward. So that would include discharges that were from January 2025 and moving forward for all of those HCAHPS surveys. The January 2026 to July 2026 refreshes will only be reporting those eight unchanged sub-measures. I'm not sure if that completely answers the question, but if they still have questions, we can certainly follow up after this is over and get an answer to them. But it's October 2026 refresh and moving forward that we'll have the updated HCAHPS survey measures publicly reported. Great. Are other languages besides Spanish being required? No. At this time, Spanish is the only required language. How many phone calls do patients get for HCAHPS? For an HCAHPS survey, patients can receive up to five phone call attempts if they have not yet completed the survey. Also, as a reminder for HCAHPS, these are live phone calls being placed by a telephone agent. So, somebody's asking again: "Can you repeat how to find the CAHPS newsletter under Resources?" I went ahead and put a link to our resources website in the attendee chat there. So you can click on that and follow along. But in that resources section, we have a lot going on. Obviously, we have newsletters, case studies, white papers, webcasts. On the right side, you'll see a little heading that says, "CAHPS," above all those little windows. If you click on that, that'll bring up all of our CAHPS Insiders. So, you can find those there. And again, like I mentioned, if you scroll down to the bottom of that page, at the bottom, very, very bottom, there's a section that says, "Newsletter Sign-Up." If you put in your email address, you'll be sure to get all of our newsletters, including our monthly CAHPS Insiders, whenever those come out. And then let's see. I think that is all we have, and that's all right because we are at time. So thank you for joining us, everybody. Again, if we didn't get to a question, we will try to follow up with you offline. Thank you so much for joining us. We hope to see you again in a few months. Thank you.