HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the first national, standardized, publicly reported survey designed to measure the perspectives of adult patients on the hospital care they receive. This uniform tool captures the consistency and quality of care from the patient’s point of view during an inpatient stay at an acute care hospital. The standardized approach ensures that data collected across different hospitals can be objectively compared. The ultimate goal of HCAHPS is to make health care more transparent, provide consumers with information, and create incentives for hospitals to improve quality of care.
The Purpose and Administration
The Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop and maintain the HCAHPS survey. This collaborative effort established a reliable methodology for measuring patient experience across the United States. Hospitals subject to the Inpatient Prospective Payment System (IPPS) must collect and submit HCAHPS data to receive their full annual payment update from Medicare. This requirement mandates the survey’s use at thousands of acute care hospitals.
HCAHPS is administered to a random sample of adult patients between 48 hours and six weeks after discharge. Data collection occurs continuously throughout the year using approved methods, which may include mail, telephone, or a combination of web and follow-up contact. The core questions ask patients to rate the frequency of an experience using standardized options like “Always,” “Usually,” “Sometimes,” or “Never.”
Key Domains of Patient Experience Measurement
The HCAHPS survey contains a core set of questions grouped into domains that reflect different facets of the patient’s interaction with the healthcare system. These domains focus on aspects of the hospital experience that patients are uniquely qualified to evaluate.
The survey measures several key areas, including:
- Communication with Nurses and Communication with Doctors: Assesses how well staff listened, explained things clearly, and treated the patient with courtesy and respect.
- Responsiveness of Hospital Staff: Gauges how quickly patients received assistance with personal needs.
- Cleanliness and Quietness of the Hospital Environment: Focuses on factors that contribute to a restful stay.
- Communication about Medicines: Explores whether staff explained the purpose and possible side effects of new medications before discharge.
- Discharge Information: Assesses whether patients received written instructions about symptoms or health problems to look out for after returning home.
Newer domains, such as Care Coordination and the Restfulness of Hospital Environment, have been added to capture a broader scope of the patient experience.
Public Reporting and Financial Impact
After CMS receives the survey data, it cleans, adjusts, and analyzes the responses to ensure fair comparisons across hospitals. The scores are adjusted to account for factors outside the hospital’s control, such as patient mix and survey administration method. The results are made publicly available four times a year on government websites, such as the Care Compare tool on Medicare.gov.
This public reporting provides transparency, allowing consumers to inform their decisions about where to seek care. The public scores also create an incentive for hospitals to improve, as poor performance is visible to the community. CMS calculates HCAHPS Star Ratings, which condense the complex survey results into a simple, consumer-friendly measure of quality.
HCAHPS scores have a direct financial impact through the Hospital Value-Based Purchasing (VBP) Program. The VBP program links a portion of a hospital’s Medicare payment to its performance on various quality measures, including patient experience. HCAHPS results contribute a significant percentage to a hospital’s Total Performance Score (TPS) within the VBP framework. Hospitals with high performance can earn back a greater incentive payment, while those with lower scores may receive a reduced payment adjustment. This structure ensures HCAHPS scores directly influence hospital revenue and drive quality improvement efforts.