HCAHPS Scores: History, Goals, and Impacts
HealthNovember 30, 2018

HCAHPS scores: History, goals, and impacts

As hospital reimbursements are increasingly tied to patient satisfaction surveys, healthcare providers have turned their attention to efforts to quantify and improve the patient care experience. As recently as the 1990s, there was no standardized method of collecting data related to patient satisfaction; instead, hospital reviews and satisfaction scores were subjective and were not necessarily indicative of the level of care and attention provided to each patient.

All that changed in the early 2000s. In 2002, the Centers for Medicare and Medicaid (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop a standardized, publicly reported survey of patients’ experiences with their hospital care. The survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS, pronounced “H-caps”), was the first national method of collecting data to measure patient satisfaction with care received at hospitals.

The HCAHPS today

The HCAHPS is comprised of 27 questions, all related to aspects of the patient’s hospital experience. In general, the survey measures a patient’s satisfaction with:

  • Communication with doctors and nurses
  • Communication about medicines
  • 3-item care transition
  • Responsiveness of hospital staff
  • Hospital cleanliness and quietness
  • Discharge information
  • Overall rating of the hospital

Goals of HCAHPS

The HCAHPS survey was developed with three broad goals in mind, which carry forward to today:

  1. Produce comparable data on patients’ perspectives of care that allows objective and meaningful comparisons among hospitals on topics that are important to consumers.
  2. Create incentives for hospitals to improve the quality of care based on public reporting of the survey results.
  3. Enhance public accountability in health care by increasing transparency through public reporting of the survey results.

Who receives the survey?

The survey isn’t limited to patients enrolled in Medicare or Medicaid. Instead, any adult patient who stays at least one night in a hospital is eligible, with the exception of patients admitted with a psychiatric diagnosis.

Patients receive the HCAHPS survey no sooner than 48 hours after discharge. Surveys may be received for up to six weeks after a patient leaves a facility. Data collection must not be undertaken while patients are still admitted to a hospital.

Impact of HCAHPS scores on hospitals

The different aspects of care included in the HCAHPS score make up the Person and Community Engagement domain, which is part of what CMS uses to measure hospital effectiveness. CMS uses this domain, along with three others, to arrive at an overall measure of hospital performance.

The Person and Community Engagement domain makes up a full 25% of a hospital’s performance tally. Other domains, including safety, clinical care, efficiency, and cost reduction, are calculated and combined to arrive at an average hospital score.

CMS rewards and reimburses hospitals based on their performance scores. The quality of care provided to Medicare patients, together with how closely best clinical practices are followed and how well a facility enhances the patient experience of care, are used to determine how much a facility receives in Medicare reimbursement.

HCAHPS and patient outcomes

But it isn’t all about money. There’s evidence that HCAHPS scores are also tied to favorable outcomes for patients. While further research is needed to determine the extent of the relationship between the two, one study indicates that large hospitals with high surgical volumes were associated with high overall patient satisfaction scores.

Additionally, lower mortality hospitals have higher patient satisfaction scores compared to high mortality facilities. But hospital characteristics and patient safety outcomes were not tied to patient satisfaction scores, indicating other factors which are not included in the HCAHPS ultimately influence a patient's perception of care. Further evaluation and research are needed to determine exactly what these other factors may be.

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