Executive Summary

The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS, pronounced “H-caps”) survey was developed collaboratively by Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research & Quality (ARHQ). The survey aims to produce data about patient experience of care that allows for objective and meaningful comparisons of hospitals. 

The questions address topics that are important to consumers, create new incentives for hospitals to improve quality of care, and enhance provider accountability in health care by increasing transparency of the quality care. CMS uses HCAHPS survey results to adjust individual hospitals’ Medicare reimbursement as part of the Value-Based Purchasing (VBP) pay-for-performance program.

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Why is the HCAHPS survey a key issue for providers?

HCAHPS survey scores indicate patient experience and overall satisfaction with the level of service provided by an organization. Not only does this impact an organization’s reputation, it also has direct and indirect reimbursement implications. Traditionally, consumers have not “shopped” for health care services. However, as consumers are moving, or being forced to move, to high deductible health plans, more patients are shopping for their care. As a result, provider reputation is a bigger factor than ever when trying to acquire and retain patients. Finally, under the Value-Based Purchasing (VBP), HCAHPS results account for 25% of the total performance score (TPS) in FY 2019.

How does the HCAHPS survey work?

The survey asks for patient feedback across several domains, including communication with nurses and doctors, responsiveness of hospital staff, cleanliness and quietness of the hospital environment, pain management, and communication about medicines. The survey is sent to a random sample of adult patients across medical conditions. Patients must have had at least one overnight stay in the hospital, but are not required to be Medicare beneficiaries. The survey is comprised of 27 questions related to the most recent stay and may be administered by mail, telephone, mail with telephone follow-up, or interactive voice recognition. Hospitals submit collected data to CMS for analysis. Within the VBP program, the Person & Community Engagement domain score for each hospital is determined by summing the hospital’s HCAHPS Base Score (0-80) and HCAHPS Consistency Score (0-20). CMS also publicly reports HCAHPS scores on its Hospital Compare website.

How does the HCAHPS survey affect providers?

Clinical

The public reporting of HCAHPS scores is meant to incentivize providers to improve quality of care. For example, to perform well on HCAHPS surveys, clinical staff must communicate effectively with patients as their ability to listen and respond to patients figures into scoring. Survey questions also specifically address patients’ perspectives on nurse care, physician care, pain management, and discharge information/instructions. As such, clinical staff are amplifying their focus on appropriately managing patients’ pain and educating discharged patients and their family members.

Financial

HCAHPS scores tie to hospitals’ Person & Community Engagement score, which comprises 25% of a provider’s TPS under Value-Based Purchasing (VBP) for FY 2019. Therefore HCAHPS performance can directly lead to positive or negative adjustments to Medicare reimbursement.

In addition, as consumers increasingly shop for care and receive word of mouth referrals, patient satisfaction will become a major driver of volumes and impact a hospitals’ revenue. 

Operational

As improving patient satisfaction rises to the top of providers’ todo-lists, many see a need for new leadership roles. In that vein, many providers have created a new C-suite level role – the Chief patient experience officer. Chief Experience Officers coordinate experience enhancement plans and benchmark initiatives to develop and test new approaches to satisfy patients. From facility design to staff training, the chief patient experience officer is tasked with ensuring patient and caregiver satisfaction throughout hospital stays.

How might the HCAHPS survey impact provider-supplier sales relationships?

The impact of a product or service on patient experience will increasingly figure into purchasing decisions. As such, products and services that improve patient experience will become more valuable.

• Ensuring Effective Communication and Education: Suppliers and service firms can provide wraparound support with their products that enable more productive or informed conversations between providers and patients. In addition, support should also apply to family members and caregivers, as they may fill out the survey on the patient’s behalf.
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• Space and design can have a considerable impact on overall experience: Innovative facility design that reduces noise or makes surfaces easier to clean can help increase a providers’ quietness and cleanliness scores.
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• Employees must ensure high levels of patient satisfaction with all clinical and non-clinical interactions: Staffing firms should train staff on how to contribute to a positive patient experience before hospital placement. In addition, vendor representatives who visit provider locations should ensure they are acting in accordance with the provider’s patient experience guidelines.

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