The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, standardized survey instrument designed to measure patients’ perceptions of their recent hospital stay. Implemented in 2006, this survey creates a uniform method for collecting and publicly reporting data on patient experience across the United States.
The Centers for Medicare & Medicaid Services (CMS) developed the HCAHPS survey in partnership with the Agency for Healthcare Research and Quality (AHRQ). By mandating its use for most hospitals that receive federal funding, CMS established a national benchmark for patient-centered care. The primary goal is to produce comparable data that allows consumers to make informed decisions about where to receive care.
Public reporting of HCAHPS results encourages hospitals to focus on improving the patient experience, fostering competition based on service quality. Hospitals must submit HCAHPS data to receive the full annual payment update from CMS. This framework enhances accountability within the healthcare system by increasing the transparency of care quality provided.
Patient Experience Survey Domains
The HCAHPS survey consists of core questions grouped into specific domains that capture various aspects of the patient’s experience. These domains focus on how often certain services or behaviors occurred, using response scales like “Never,” “Sometimes,” “Usually,” or “Always.” The questions deliberately avoid clinical quality assessments, instead concentrating on communication and the hospital environment.
One major area is Communication with Nurses and Doctors, which assesses how clearly and respectfully patients felt their care team explained things. Similarly, the Responsiveness of Hospital Staff domain measures how quickly patients received help with needs such as using the restroom or receiving a call light response.
Other domains include the Cleanliness and Quietness of the Hospital Environment, which gauge the physical comfort level during the stay. The survey also focuses on key aspects of preparation for leaving the hospital, specifically Communication about Medicines and Discharge Information. Questions in these areas determine if patients received adequate information about new medications and what symptoms to watch for after returning home.
Finally, two global items—Overall Rating of the Hospital and Willingness to Recommend the Hospital—provide a broad, summary measure of the patient’s entire experience.
Scoring Methodology and Public Access
The raw responses from the HCAHPS surveys are converted into publicly reported scores through a specific methodology to ensure transparency and fairness. The most common metric is the “Top Box” score, which represents the percentage of patients who selected the most positive response option for a given measure. For instance, in the communication domains, the “Top Box” is the percentage of patients who answered “Always.”
To make comparisons between hospitals fair, the raw data undergoes risk adjustment before public reporting. This process accounts for factors outside a hospital’s control that are known to influence patient responses, such as a patient’s age, education level, and general health status.
The final, adjusted scores are then made available to the public four times per year, typically reflecting four consecutive quarters of data. CMS publishes these results on its official website, often found under the Care Compare tool on Medicare.gov. This public reporting mechanism is designed to empower consumers by providing easy access to data on patient experience, allowing them to compare hospitals in their area against national averages.
The public data also include Star Ratings, which simplify the complex survey results into a single visual rating for each hospital. A hospital must have a minimum number of completed surveys over a four-quarter period to receive a Star Rating. This rating system further supports the transparency and consumer-choice goals of the HCAHPS program.
Link to Hospital Reimbursement
The financial performance of hospitals is directly connected to their HCAHPS scores through the CMS Hospital Value-Based Purchasing (VBP) Program. The VBP program is designed to reward hospitals with incentive payments for the quality of care they provide, rather than simply the volume of services. This mechanism links a portion of federal funding to performance on various quality metrics.
HCAHPS performance is incorporated into the VBP Total Performance Score (TPS) under the Person and Community Engagement (PCE) domain. Consequently, a hospital’s patient experience score directly influences its potential Medicare reimbursement.
The VBP program operates by withholding a small percentage of all participating hospitals’ Medicare payments, which is then pooled to fund the incentive payments. Hospitals can earn back or exceed this withheld amount based on how well they perform on quality measures, including the HCAHPS domains. The financial impact can be substantial, as poor performance can result in a net loss of Medicare payments.
The use of HCAHPS scores in the VBP program is a mandatory metric that ties quality of experience to funding, reinforcing the importance of patient perception in the modern healthcare environment.