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National Hospital Associations Release Paper Calling for Updates to Patient Experience Survey to Improve Patient Care

July 30, 2019

During 2008, the federal government introduced a standardized survey to measure patients' perspectives about hospital care. The Centers for Medicare & Medicaid Services publishes participating hospitals’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results on the Hospital Compare website four times a year.

The HCAHPS survey is designed to:

  • Produce data about patients’ perspectives of care that allow for meaningful and objective comparisons of hospitals
  • Provide public reporting of survey results that create incentives for hospitals to improve quality of care
  • Provide public reporting that enhances accountability in health care by increasing quality transparency

Patient experience also is used as a measurement for value-based payments that hospitals receive through federal programs.

The HCAHPS survey includes 32 questions that deal with critical aspects of the hospital experience, such as communication with doctors and nurses, cleanliness and quietness, pain management, and discharge information. The survey is administered to a random sample of adult patients across medical conditions using mail, telephone, mail with telephone follow-up, or active interactive voice recognition.

Recently, five major hospital associations released a paper which makes recommendations for updating the HCAHPS survey to better reflect the many changes and advancements that have happened in health care during the last 10 years. The associations interviewed hospital and health system patient experience leaders (PEL), the people who operate and manage the patient experience activities within their organizations.

The Modernizing the HCAHPS Survey: Recommendations from Patient Experience Leaders identified five key findings:

  • Response rates are falling––Patient experience leaders (PEL) found that their HCAHPS survey response rates were falling each year. The national rate of patient responses dropped from 33% in 2008 to 26% in 2017. Low response rates erode the validity of the survey.
  • There is consensus that the HCAHPS survey should be updated––While most PELs thought the HCAHPS survey does provide patients with solid comparable data on patient experience, all felt the survey needs to be improved.
  • Topics covered are important but incomplete––When asked to identify the questions that were most important to keep, PELs identified eight of the 27 core questions, including questions related to communication with doctors and nurses. PELs identified five topics/questions they would like to see added to the survey, such as the efficiency and team-work of the care team.
  • Research is needed on other Factors that influence the patient experience––More research needs to be done to identify social determinants of health that are outside of the hospital’s influence but do impact the HCAHPS survey scores. This would ensure a level playing field when comparing hospitals.
  • Consumer literacy levels need to be re-evaluated. PELs believe that the health literacy level of the survey was too high and that responses from patients with lower health literacy levels were not being captured adequately. PELs pointed out the absence of appropriate literacy levels in non-English language HCAHPS survey versions. These segments of the population risk being under-surveyed.

PELs also offered recommendations to inform future efforts to improve the HCAHPS survey:

  • Add a digital method of delivery to existing modalities
  • Shorten survey
  • Revise the survey in light of today’s shift to value-based care, changes in health care delivery, improvements in technology, and evolving patient priorities
  • Reframe the care transitions and discharge planning sections of the survey
  • Assess patient literacy, wording of questions, and non-English language preferences
  • Periodically re-evaluate the HCAHPS survey
  • Increase consumer awareness about the HCAHPS survey

The paper was co-authored by the Federation of American Hospitals, American Hospital Association, America's Essential Hospitals, the Association of American Medical Colleges, and the Catholic Health Association of the United States.

HAP urges consumers to use the Hospital Compare HCAHPS information as one of many sources when making health care decisions. Always consult with your family physician or specialist as well.

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