As NLP and Machine Learning consultants, part of what we do is analyze data – primarily text data in combination with structured data to help organizations make informed decisions.
However, when it came down to analyzing the HCAHPS survey data, there was a lot of confusion around what the HCAHPS is, how it works, and how it relates to reimbursement even amongst administrators.
To better understand HCAHPS, we ended up writing down all the HCAHPS questions that we had and looked for answers to each one based on research in trusted sources. We documented the answers in this post, with the hope that it’ll help hospital administrators, patient experience leaders, and professionals who work with surveys.
- What is the HCAHPS survey?
- When did the HCAHPS survey start?
- When do patients take the survey?
- Is HCAHPS for inpatient care only?
- What type of information does HCAHPS capture?
- What are some HCAHPS Questions?
- How many hospitals participate in the survey?
- Where is HCAHPS headed?
- How does low HCAHPS scores affect your hospital?
- How to analyze HCAHPS data ?
What is the HCAHPS survey?
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey which used to be a 27-item survey, is now a standardized 32-item survey of patients’ perspectives of hospital care. This is a publicly reported survey.
The HCAHPS Survey was developed by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ).
While hospitals have been collecting information on patient satisfaction for their own internal use using services like Press Ganey, until HCAHPS, there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals.
HCAHPS also referred to as H-Caps, was designed to address 3 broad goals :
#1. Comparison of patients’ perspectives of care
This survey serves as an instrument that allows for objective and meaningful comparisons of hospitals on topics that are important to consumers.
#2. Improve quality of care
Because the survey is publicly reported, this creates new incentives for hospitals to improve quality of care.
Through public reporting, the survey serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.
When did the HCAHPS survey start?
The information from the HCAHPS Survey began to be collected in 2006. In 2008, the information from the surveys was first publicly reported.
CMS reports the results of the survey for each hospital on the Hospital Compare website. The results published online are based on the past four consecutive quarters, with the oldest quarter being discarded when a new quarter arrives.
When do patients take the survey?
The survey is administered between 2 and 42 days after discharge to a random sample of adult patients. There are four modes of administration which includes Mail, Telephone, Mixed (mail with telephone follow-up), and Interactive Voice Response. Unfortunately, the survey is not available online.
Is HCAHPS for inpatient care only?
The HCAHPS survey is for inpatient care only. The OAS-CAHPS collects information about outpatient care.
What type of information does HCAHPS capture?
The HCAHPS Survey captures the patient’s experience of communication with doctors and nurses, responsiveness of hospital staff, communication about medicines, cleanliness and quietness of the hospital, discharge information, transition to post-hospital care and overall rating of the hospital.
What are some HCAHPS Questions?
Here are 10 questions from the HCAHPS survey, just to give you an idea of what’s being asked. Note that all of these HCAHPS questions are structured, meaning, no free-form comments are permitted.
- how often did nurses treat you with courtesy and respect?
- how often did nurses listen carefully to you?
- how often did nurses explain things in a way you could understand?
- how often did doctors treat you with courtesy and respect?
- how often did doctors listen carefully to you?
- how often did doctors explain things in a way you could understand?
- how often did hospital staff tell you what the medicine was for?
- how often did hospital staff describe possible side effects in a way you could understand?
- did hospital staff talk with you about whether you would have the help you needed when you left the hospital?
- did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
Here is the full list of questions.
How many hospitals participate in the survey?
Over 4,000 hospitals participate in HCAHPS and over 3.0 million patients complete the survey each year.
Where is HCAHPS headed?
In 2018, patient experience leaders found that response rates to the HCAHPS survey have been falling (from 33% in 2008 to 26% in 2017). Some of the contributing factors to the drop in response rates include (a) too many questions to answer which frustrates patients and (b) the lack of a digital way of responding to surveys (right now phone and mail are the only options). The patient experience leaders suggest that addressing these issues could improve future response rates.
Other recommendations from patient experience leaders to modernize the HCAHPS survey include:
- 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 HCAHPS survey
- Periodically re-evaluate the HCAHPS survey
How does low HCAHPS scores affect your hospital?
Low HCAHPS scores can hurt a hospital in two ways. First, by damaging the facility’s reputation, since scores and star ratings for hospitals can be compared by patients online when deciding on a care location.
Second, low HCAHPS scores can decrease a hospital’s Medicare/Medicaid reimbursement through CMS. CMS currently withholds 1% of hospitals’ Medicare reimbursement as part of its Hospital Value-Based Purchasing Program, restoring it to institutions based upon their quality performance. Thirty percent of the program’s financial incentive is based upon how well hospitals score on patient satisfaction, as measured by HCAHPS survey.
As there is a direct association between brand reputation and the ability to capitalize on market share and reimbursement, it’s important to address the reasons behind your low HCAHPS scores. This starts with analyzing your data and understanding where your organization is falling short.
How to analyze HCAHPS data ?
The HCAHPS data is publicly available for download from data.medicare.gov. This website provides some basic visualization capabilities as shown below.
However, to answer custom questions like comparisons of ratings between facilities in your hospital system, you would have to perform custom data analysis using tools like R, Python and SAS. With this you’ll have to download the dataset, extract relevant data points, clean the data and then perform the analysis.
If you just need a quick view of how your hospital facilities are doing individually, you can use the Hospital Compare website meant primarily for consumers, but of course administrators could use it too.
Hospital Compare gives you a quick view of how your hospital is doing compared to State average and National average on specific dimensions.
For example, here’s how the Salt Lake Regional Medical Center is performing on the nurse communication topic.
The chart above clearly tells us that the Salt Lake Regional Medical Center’s performance is below average when comes to nurse communication and there’s definitely room for improvement. Once you have this information, you can start looking into the why’s. One way to get into the why’s is to use patient comments from surveys, formal complaints as well as online reviews. Here’s an article we wrote that talks about the types of insights you can get by analyzing patient comments.