The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a standardized instrument developed by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). Its purpose is to introduce a national standard for measuring and publicly reporting patients’ perspectives on the care they receive during a hospital stay. Before HCAHPS, hospitals used various internal patient satisfaction surveys, making objective comparisons across institutions impossible. The current survey contains 29 questions divided into core domains, which allow for the uniform collection of data used to drive quality improvement and increase accountability in healthcare.
The Core Domains Measured by the HCAHPS Questions
The 29 HCAHPS questions are grouped into conceptual domains that assess the patient’s interaction with the hospital environment and staff. Nineteen questions are substantive items focused on the patient experience, while the remainder are screening and demographic items used for analytical adjustments. These substantive questions form the basis for the publicly reported measures.
Major domains include Communication with Nurses and Communication with Doctors, evaluating how often providers listened carefully, explained things clearly, and treated patients with courtesy and respect. The Responsiveness of Hospital Staff domain measures how promptly patients received assistance, such as help using the bathroom or getting to a commode. These composite measures reflect the patient’s direct interactions with the care team.
Other domains address the hospital setting and logistical aspects of care, such as the Cleanliness of the Hospital Environment and the Quietness of the Hospital Environment. Patients are asked about the tidiness of their room and bathroom, and how often the area around their room was quiet at night. Communication about Medicines focuses on whether staff explained the purpose and possible side effects of new medications before administering them.
The final stages of care are covered by the Discharge Information and Care Transition domains. Discharge Information asks whether patients received written instructions about symptoms or health problems to look out for after leaving the hospital. Care Transition assesses the patient’s understanding of post-discharge needs and whether they had help arranging follow-up care. The survey concludes with two global questions: Overall Hospital Rating and Willingness to Recommend the Hospital, which provide a summary assessment of the entire experience.
How the Survey Is Administered
The HCAHPS survey is administered to a random sample of adult inpatients, regardless of payment source, who are discharged between 48 hours and six weeks prior to receiving the survey. Specific populations, such as those discharged to hospice or psychiatric patients, are excluded to ensure the data reflects the general acute care experience. This standardized sampling methodology collects uniform information across all participating hospitals.
To maintain scientific rigor and allow for valid comparisons, CMS controls the approved modes of survey administration. Hospitals or their approved vendors must use one of four primary methods: mail-only, telephone-only, a mixed mode combining mail with telephone follow-up, or Active Interactive Voice Response (IVR). Adherence to these protocols is necessary because the mode of delivery can influence patient responses.
Data collection occurs continuously throughout the year, ensuring a rolling 12-month period of patient feedback is available. Smaller hospitals may be required to survey all eligible discharges, while larger hospitals use a sample. Hospitals are prohibited from changing their chosen sampling or administration mode within a calendar quarter to maintain data integrity.
Public Reporting and Use of HCAHPS Scores
The data collected from the 29 questions is central to federal quality reporting and payment programs, in addition to internal hospital use. CMS publicly reports HCAHPS results four times a year on the Care Compare website, promoting transparency and allowing consumers to make informed choices about care. This public reporting creates a strong incentive for hospitals to improve performance.
HCAHPS scores are directly linked to hospital accountability through the CMS Value-Based Purchasing (VBP) Program. The VBP program adjusts a hospital’s Medicare payments based on its performance across a set of quality measures, with HCAHPS being a significant component. Patient experience accounts for a portion of the hospital’s Total Performance Score, which determines whether the institution receives an incentive payment or a reduction in reimbursement.
Hospitals that fail to comply with HCAHPS reporting requirements may face reductions in their Annual Payment Update (APU) from Medicare. This financial connection transforms patient feedback into a factor that directly influences hospital revenue and encourages quality improvement initiatives. Specific domains, such as Communication with Nurses and Responsiveness of Hospital Staff, are weighted measures within the VBP program, making them targets for quality improvement efforts.