July 25, 2019 – Today, five major hospital associations released Modernizing the HCAHPS Survey: Recommendations from Patient Experience Leaders, a paper that explores how to update patient experience surveying to best improve patient care.

The HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) is a 32-question patient satisfaction survey required by CMS for all U.S. hospitals. Researchers found that response rates to the HCAHPS survey are falling and that after ten years in the field, the survey needs a refresh. Recommendations include the creation of a digital avenue for patients to respond to the survey (right now phone and mail are the only options), as well as shortening the survey. A full list of key findings and recommendations can be found below.

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

“Great hospital care needs to be patient centered. Providing the best care, meeting patient expectations and keeping them comfortable and well informed is key,” said FAH President and CEO Chip Kahn. “Updating and improving the HCAHPS survey could have a major impact on improving care.”

“Being a nurse on the frontlines of providing care showed me why including the patient experience is crucial in order to have a complete quality picture,” said Robyn Begley, chief nursing officer of the American Hospital Association and chief executive officer of the American Organization for Nursing Leadership. “America’s hospitals and health systems believe strongly that HCAHPS is a critical patient experience survey that has important benefits for both patients and the providers that care for them. But, as our report clearly lays out, it is time to re-think HCAHPS to ensure it is capturing information on critical aspects of care as it is delivered today and that patients can choose to provide their responses in the way that is most convenient for them.”

“Our hospitals work hard to overcome the social and economic challenges their vulnerable patients face and that affect the care experience – language barriers and low health literacy, for example,” said Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals. “This research shows more work is needed to ensure all hospitals ask the right questions in a culturally competent, easily understood way and without burdening patients or providers.”

“This important work demonstrates the commitment of hospitals in improving the experiences of care for patients. Our recommended approaches to modernizing the HCAHPS survey to reflect changes in health care delivery and advancements in technology will help ensure patients are empowered to provide valuable feedback,” said Janis Orlowski, MD, chief health care officer of the Association of American Medical Colleges.

“The patient is at the center of all we do as Catholic healthcare. An updated HCAHPS survey will give us a better understanding of how patients experience the care they receive in our hospitals and how we can improve our care delivery,” said Sr. Mary Haddad, CHA President and CEO.

The associations interviewed hospital and health system patient experience leaders (PELs), the people who operate and manage the patient experience activities within their organizations. This allowed the authors to gather real world insights into the effectiveness of the HCAHPS. The paper examines in detail the current survey and the way it can be updated to better reflect the many changes and advancements that have happened in health care over the last 10 years.

KEY FINDINGS

• Response Rates Are Falling. PELs found that their HCAHPS survey response rates were falling each year. We examined national data and identified a drop in the national rate of patient responses from 33% in 2008 to 26% in 2017. Low response rates erode the validity of the survey.
• There Is Consensus the HCAHPS Survey Needs Updating. While most PELs thought the HCAHPS survey’s ability to provide patients with comparable data on patient experience was good, all felt the survey needs improvement.
• Topics Covered Are Important but Incomplete. When asked to identify the questions most important to keep PELs identified eight of the 27 core questions including questions related to communication with doctors and nurses. PELs further identified five topics/questions they would like to see added to the survey, such as questions related to efficiency and team-work of the care team.
• Research Is Needed on Additional Factors That Influence Patient Experience. More research needs to be done to identify social determinants of health that are outside of the hospital’s influence that impact the HCAHPS survey scores to ensure a level playing field when comparing hospitals.
• Literacy Levels Need to Be Re-evaluated. PELs generally felt that the health literacy level of the survey was too high and that responses of patients with lower health literacy levels were not being captured adequately. PELs also indicated the absence of appropriate literacy levels in non-English language HCAHPS survey versions. These segments of the population risk being under-surveyed and are not properly represented in the reported HCAHPS survey results. 

TOP RECOMMENDATIONS

• Add a digital mode 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 HCAHPS survey; and
• Periodically re-evaluate the HCAHPS survey. 

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