The intent of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals currently collect information on patients' satisfaction with care, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. In order to make "apples to apples" comparisons to support consumer choice, it is necessary to introduce a standard measurement approach. HCAHPS can be viewed as a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS is meant to complement the data hospitals currently collect to support improvements in internal customer services and quality related activities.
Three broad goals have shaped the HCAHPS survey. First, the survey is designed to produce comparable data on the patient's perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Third, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS project has taken substantial steps to assure that the survey will be credible, useful, and practical. This methodology and the information it generates will be made available to the public.
In May 2005, the National Quality Forum (NQF), an organization established to standardize health care quality measurement and reporting, formally endorsed the CAHPS Hospital Survey. The NQF endorsement represents the consensus of many health care providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations.
HCAHPS® Development
The Centers for Medicare & Medicaid Services (CMS) has partnered with the Agency for Healthcare Research and Quality (AHRQ), another agency in the Department of Health and Human Services, to develop HCAHPS. AHRQ has carried out a rigorous, scientific process to develop and test the HCAHPS instrument. This process has entailed multiple steps, including a public call for measures; review of existing literature; cognitive interviews; consumer focus groups; stakeholder input; public response to several Federal Register notices; a three-state pilot test; consumer testing; and small-scale field tests.
The HCAHPS survey is composed of 27 items: 18 substantive items that encompass critical aspects of the hospital experience (communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain control, communication about medicines, and discharge information); four items to screen patients to appropriate items; three items to adjust for the mix of patients across hospitals; and two items to support congressionally-mandated reports.
In May 2005, the 27-item HCAHPS survey was formally endorsed by the National Quality Forum (NQF), a voluntary consensus standard-setting organization established to standardize healthcare quality measurement and reporting. The NQF endorsement represents the consensus of many healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. Acting upon a NQF recommendation, CMS commissioned an independent research firm, Abt Associates, Inc., to conduct an analysis of the benefits and costs of HCAHPS. The Abt report, which includes detailed cost estimates for hospitals, can be found at the link below. On November 7, 2005, CMS published the final public call for comments on the HCAHPS survey, with a 30-day public comment period.
Why You Need to Participate
According to CMS’ press release on November 1, 2006, hospitals will be required to participate in HCAHPS to receive a full payment update. Also, hospitals must report risk-adjusted outcome measures to receive the full payment update, including 30-day mortality measures for patients hospitalized with an acute myocardial infarction.
Additionally, The CMS HCAHPS initiative is moving from a “pay-for-participation” to a “pay-for-performance” requirement. Those hospitals that score better on HCAHPS will receive larger reimbursements from CMS than those that score lower. CMS is in the early stages of making HCAHPS-like measurement instruments for Outpatient and Emergency patient experiences, and they have already released similar tools for ambulatory surgery and the clinical office.
Self Administration or Outsource?
Hospitals that choose to self-administer HCAHPS internally must go through all of the following steps, as required by CMS:
- You must have continuously performed internal patient surveys for the past year before CMS will allow you to administer HCAHPS internally
- Program participation form must be completed
- Apply for exceptions as needed
- Attend HCAHPS training
- Establish and maintain a toll free customer help line
- Participate in Dry Run
- Review/follow HCAHPS Quality Assurance Guidelines and policy updates
- Become a registered user of the QualityNet Exchange
- Participate in onsite visits by CMS as requested
- Acknowledge review of and agreement to Rules of Participation
- As part of the Quality Assurance Plan requirements, you must implement monitoring and quality oversight systems that include: tracking of fielded surveys and responses, data collection and storage of data, training of customer support personnel, data entry personnel and telephone interviewers, safeguarding patient confidentiality, and strict data security policies
If you engage HealthStream Research as your HCAHPS partner, you’ll only have to:
- Submit patient lists to HealthStream Research
- Select HealthStream Research as your HCAHPS partner via CMS’ online QualityNet Exchange
- Participate in the Dry Run
That’s it. We even provide assistance with all steps! HealthStream Research will ensure that HCAHPS administration (for both the Dry Run and the full HCAHPS) places a minimal burden on your hospital.
How HealthStream Research Can Help
HealthStream Research’s HCAHPS services provide:
- Dedicated HCAHPS Experts: HealthStream Research provides an on-call dedicated HCAHPS expert for all HCAHPS clients.
- Low Cost
- Peace of Mind: With the constantly changing HCAHPS landscape, HealthStream Research will ensure your full compliance with all CMS requirements
- Dedicated HCAHPS Toll Free Patient Assistance Line: Your patients can call 1-888-900-7436 at any time for assistance with HCAHPS questions or issues
- Direct CMS Contact and Local HCAHPS Advocacy: HealthStream Research is in constant contact with CMS and we’re right in their backyard—as needed, HealthStream Research can be in CMS’ offices in less than 30 minutes to represent your concerns!