M3-Patient Experience : Top Box, Skipped Questions, and How 0% Ratings Happen

Share this Article

In this week’s Thinking Thursdays TIPs we cover some practical items.

  • Top Box Score: How is it Calculated and Does it Include Skipped Questions
  • What happens when a patient skips a question?
  • How Can a Provider Have a 0% Top Box Score

Let us know if you have other items that you would like for us to cover! We’d love to hear from you.

Happy Reading!

Top Box Score: How is it Calculated and Does it Include Skipped Questions

Over that last several years the “Top Box” score has become the go-to metric for many healthcare organizations. While Average Ratings are still used, CMS (Centers for Medicare and Medicaid Services), and other national level organizations rely heavily on the use of Top Box scores when measuring and comparing service quality across healthcare.

So, exactly what is “Top Box”? The “Top Box” score refers to the percentage of survey respondents that give the most positive response available. For example, using the question with the 4-point rating scale below, a rating of “Always” is considered the Top Box answer.

In the last 6 months, how often are the clerks and receptionists at this provider’s office as helpful as you thought they should be?

  • Always
  • Usually
  • Sometimes
  • Never

As far as how the Top Box score is calculated, it’s actually pretty straight forward; simply count the number of patients that provided a Top Box answer (Always in this example) and divide by the total number of patients that answered that particular question.

To keep the math simple, let’s say 10 patients answered the Receptionist Helpful question above and six (6) of those patients provided a rating of “Always”. The Top Box score is calculated as: 6 divided by 10, multiplied by 100, e.g., (6 / 10 x 100 = 60% Top Box).

Whenever a patient skips a question, or does not answer for whatever reason, that patient’s “missing” response is completely ignored and it does NOT impact the Top Box score, good or bad.

If you would like to double-check your practice’s Top Box scores, just follow these steps.

  1. Login to M3-Patient Experience
  2. Click “Reporting”
  3. Click “Detailed Results”

From the “Detailed Results” page, select a date range and then click “Export Ratings to Excel”. A spreadsheet will appear that contains the detailed survey response data for your practice.

Helpful TIP: Whenever you are downloading a significant amount of data, use the “Export Numeric to Excel” feature, which will download answer values instead of answer text.

When you open the spreadsheet you’ll see column headings across the top of the page. Scroll to the right and find the column heading representing the question that you would like to double check. From the selected column, count the total number of patients that answered the question. Now, from that same column, count the number of patients that provided the best possible answer, i.e. “Always” or “4” on the 4-point scale, or “Strongly Agree” or “5” on the 5-point scale. On the questions that use a 0 to 10 point scale, such as the Provider Rating question, a score of a “10” or a “9” counts as a Top Box answer. Counting both 10’s and 9’s as Top Box answers aligns with CMS’ scoring methodology and other national healthcare organizations.

Please know that “Detailed Results” will include the patient’s name and other information considered PHI, as such, please remember to treat and handle “Detailed Results”, and other M3 reports, so that all HIPAA regulations are met.

What Happens When a Patient Skips a Question?

That is a great question!

When questions are skipped, or omitted, the practice’s patient experience scores are NOT impacted, good or bad. Skipped questions are completely ignored.

Many of the M3-Patient Experience questionnaires have built-in skip logic that intentionally omits certain questions, based on the patient’s unique visit experience, which often follows survey sampling protocols from CMS/CG-CAHPS.

For example, the “Acute Access” question has a preceding question that qualifies whether or not the patient has had the need to come in for an acute illness or injury.

1. In the last 6 months, did you contact this provider’s office to get an appointment for an illness, injury, or condition that needed care right away?

  • Yes
  • No

When the patient answers “No”, the next question is skipped and never presented to the patient.

2. In the last 6 months, when you contacted this provider’s office to get an appointment for care you need right away, how often did you get an appointment as soon as you needed?

  • Always
  • Usually
  • Sometimes
  • Never

Whenever the patient answers “No” to the qualifying question, question #1 in this example, the next question, question #2, is completely omitted from the patients question set. Whenever the patient answers “Yes” to the qualifying question #1 then question #2 is asked.

As mentioned, an answer of “Always” is considered the Top Box answer and is counted toward the practices Top Box score.
Should the patient answer “No” to question #1 and question #2 in not answered, please know that any unanswered, or skipped questions are completely ignored and do NOT impact the practices Top Box score — good or bad.

How Can a Provider Have a 0% Top Box Score?

When the number of completed surveys is very small, say two or three completed surveys, it is not usual to see a Top Box percentage of 0% — don’t panic — it’s likely because too few patients have completed the survey for that provider.

As previously mentioned, Top Box scores, also known as Percent Best scores, are calculated by dividing the number of Top Box ratings by the total number of patients that answered that particular question.

For example, let’s say a provider has had just three (3) patients answer the “Same Day Call Back” question.

In the last 6 months, when you contacted this provider’s office during regular office hours, how often do you get an answer to your medical question that same day?

  • Always
  • Usually
  • Sometimes
  • Never

For this example, let’s assume patient ratings were as follows:

Patient #1 answered “Usually”
Patient #2 answered “Usually”
Patient #3 answered “Sometimes”

Because none of three patients answered with “Always” as their rating, the percentage of Top Box answers calculates to 0%. The Top Box calculation is; 0 divided by 3 = 0 x 100 = 0%.

As soon as at least one patient provides an “Always” answer, the Top Box percentage will show a percentage higher than 0%.
I mentioned it before, but it’s worth mentioning again. If a patient does not answer a question, the skipped question does not impact the M3 score — good or bad — skipped question are completely ignored.

We hope you are finding Thinking Thursdays TIPs useful. If so, drop me an email (hit reply) and let me know your thoughts.

Please let our support team know if you need anything. Whenever you need help, please find support at www.medicalgps.com/support.

Just save the support link to your favorites and simply click it when you need assistance. If you don’t see what you need, after the support page loads up, scroll down and click, “I have a question not listed here?”

Have a great Thinking Thursday!


Jerry L. Stone
MedicalGPS, LLC

Leave a Reply

Your email address will not be published. Required fields are marked *