Baird Group has been conducting healthcare mystery shopping—or secret shopping—research since 1994. We were a pioneer in this type of research in the healthcare industry and we’ve conducted 1000’s of projects over the past 30 years.
We know that secret shopping can have a significant positive impact on the patient experience because we’ve seen that impact! We’ve been able to explain the why behind the survey scores plus so much more. Through direct observation, we report the facts and the feelings from the consumer’s perception and make meaningful recommendations for improvement.
So we were very excited to see that CMS is now requiring secret shopper surveys for Qualified Health Plan (QHP) issuers in Federally-facilitated Exchanges (FFEs). After all, we have been doing these studies for decades and have benchmark data on access including wait time for appointments and consumer perceptions about wait times.
What CMS is Looking For
CMS is interested in gathering firsthand data on patient experiences related to appointment access in primary care and behavioral health. The program is designed to ensure that healthcare providers are meeting CMS standards related to:
- Appointment availability and wait times.
- Quality of patient-provider interactions.
- Accuracy of information provided to patients.
- Compliance with non-discrimination policies.
- Accessibility for individuals with disabilities.
Baird Group’s highly experienced secret shoppers will assess these factors, posing as patients to get real-world and real-time insights into healthcare systems’ practices.
If your facility falls under these guidelines, the time to act is now. We’re already seeing signs of some organizations scrambling to meet these requirements by the first of the year. Surveys must be conducted between January 1 and May 31 of each plan year. That really doesn’t leave a lot of time to prepare, find a vendor, communicate with staff and ensure that you’re meeting all of the requirements under these guidelines.
There are risks to not acting quickly.
Potential Consequences of Delay
There are several potential consequences for healthcare organizations that delay preparations for the CMS secret shopping program, including:
- Failure to meet the compliance standards. The standards require that organizations are able to schedule appointments within specified timeframes at least 90% of the time.
- Not having a contracted provider in place. CMS says that: “Issuers that fail to have a third-party entity conduct the secret shopper survey, fail to report the results, or report results that do not reflect compliance with the appointment wait time standards…would need to add more contracted providers to the network to achieve alignment with the standards.”
- Rushing to implementation. Delays can lead to rushed implementation which could result in errors or incomplete preparation. Delaying preparation could also result in the inability to address appointment availability issues before official surveys begin.
Ultimately, CMS ratings and your organization’s brand and reputation could suffer.
Important Next Steps
Don’t procrastinate! Baird Group can help you implement your own secret shopping program to identify and address any potential issues before CMS evaluators arrive. Based on these results, you’ll want to have time to develop clear protocols and invest in staff training to address any gaps and ensure consistency across your organization.
Tags: CMS Secret Shopping, CMS standards, Federally-facilitated Exchanges (FFEs), healthcare mystery shopping, healthcare secret shopping, mystery shopping, Qualified Health Plan (QHP), secret shopping
