The Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS (pronounced “H-caps”), is a national, standardized survey instrument designed to measure the patient’s perspective on hospital care. This survey creates a uniform and publicly reported metric for evaluating the patient experience across the United States. This focus shifts the assessment of quality beyond traditional clinical outcomes to include the patient’s lived experience during their hospital stay, allowing for objective comparisons between hospitals.
Defining the Survey and Its Purpose
The HCAHPS survey is a federal initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). It represents the first national, standardized tool for collecting and publicly reporting patient perspectives of hospital care. The core purpose of the survey is to standardize the measurement of patient experience, ensuring that comparisons between hospitals are meaningful and fair. Prior to its implementation, patient satisfaction metrics varied widely, making national comparisons impossible.
The original survey instrument contained 32 questions, but changes in late 2019 resulted in the current 29-question core survey. These questions are administered to a random sample of adult patients between 48 hours and six weeks following their discharge from the hospital. The standardized protocol for sampling and data collection is strictly defined by CMS to maintain the integrity and statistical reliability of the results. This framework ensures that all hospitals are evaluated using the same patient experience metric.
Key Topics Covered by the Survey Questions
The 29 HCAHPS questions are grouped into several composite measures, each designed to evaluate a specific aspect of the patient’s experience. The questions focus on the frequency of positive experiences, often asking patients how often a particular action occurred, using response options like “Always,” “Usually,” “Sometimes,” or “Never.”
Communication and Staff Interaction
Two composite measures focus on communication with clinical staff: Communication with Nurses and Communication with Doctors. Patients are asked how often staff listened carefully to them and explained things in a way they could understand. The Responsiveness of Hospital Staff evaluates how quickly and effectively patients received help when they needed it. This measure assesses the staff’s promptness in meeting patient needs, such as help with using the restroom.
Environment and Comfort
The survey includes the Cleanliness of the Hospital Environment and Quietness of the Hospital Environment as separate composite measures. These questions gauge the patient’s experience regarding the upkeep of their room and the degree of noise control during the day and night. The survey also includes questions focusing on Pain Management, asking whether hospital staff did everything they could to help the patient with their pain.
Discharge and Follow-Up
The Communication about Medicines composite asks patients if staff explained the purpose and possible side effects of new medications before they were administered. The Discharge Information domain assesses whether patients received written information about symptoms or health problems to monitor after leaving the hospital. An additional domain, Care Transition, covers whether staff discussed the help a patient would need after discharge and whether a patient’s care preferences were considered.
Global Ratings
The HCAHPS instrument includes two global rating items that are reported independently. These are the Overall Rating of Hospital on a scale from 0 to 10 and the patient’s likelihood of Recommending the Hospital to others. These two questions summarize the patient’s entire experience and are influential in public reporting.
Public Transparency and Hospital Reimbursement
Once the HCAHPS data is collected and analyzed, the results are used for two primary applications: public reporting and financial incentives.
Public Reporting
The results are made publicly available on websites like Medicare.gov’s Care Compare tool, which provides consumers with transparent information. This public disclosure allows potential patients to objectively compare hospitals based on the experiences of former patients, thereby influencing consumer choice and encouraging competition in quality. The scores are updated quarterly, ensuring the data remains current for public review.
Financial Incentives
HCAHPS results are formally integrated into federal payment systems. The Centers for Medicare & Medicaid Services utilizes HCAHPS data within its Hospital Value-Based Purchasing (VBP) Program. Under the VBP program, a portion of a hospital’s Medicare reimbursement is withheld and then redistributed based on performance across four domains. The Patient and Community Engagement domain is based entirely on HCAHPS results.
The HCAHPS scores contribute a significant percentage to a hospital’s total performance score in the VBP program, making patient experience a major factor in determining revenue. Hospitals with higher scores receive a greater share of the withheld funds, potentially earning a bonus, while those with lower scores may receive less than the amount initially withheld. This mechanism directly links the quality of the patient’s experience to the hospital’s financial outcomes.