Major hospital groups recommend changes to HCAHPS survey

THE AMERICAN HOSPITAL ASSOCIATION, the Federation of American Hospitals and three other major hospital groups last week called for substantial changes to the CMS-mandated patient experience survey.

In a new report the hospital groups argued the Hospital Consumer Assessment of Healthcare Providers and Systems survey, commonly referred to as HCAHPS, is outdated and in need of an overhaul. The CMS has required hospitals to give patients the HCAHPS survey as part of Medicare participation since 2007.

“We are a decade into this. … We are in need of a serious update,” said Chip Kahn, CEO of the Federation of American Hospitals. “Care in hospitals is vastly different” than 13 years ago.

The hospital groups have a key ally in their effort to change the survey: the CMS. The agency has sought public feedback on ways to improve the HCAHPS survey, a spokeswoman said in an email. Additionally, later this year the CMS plans to solicit feedback from recent patients about how the survey can be improved.

“CMS believes that ongoing review and evaluation are vital for HCAHPS to continue to fulfill its mission of offering a national standard for collecting and publicly reporting information about patient experience of care,” the spokeswoman said.

The report from the hospital groups outlined several major changes to the survey, including adding an electronic version, shortening the length, changing questions and reevaluating the survey every few years. The recommendations were based on feedback from patient experience leaders at 27 hospitals and health systems nationally. About 44% of participants were based in teaching facilities.

A digital version of the survey is a “commonsense thing to do,” said Robyn Begley, AHA’s chief nursing officer.

The HCAHPS survey can now only be completed through mail or over the phone, which has likely contributed to the steadily declining response rates. The hospital groups would like computer and smartphone versions of the survey.

The CMS seems to support an electronic survey. The spokeswoman said the agency is currently waiting for approval to test an email version.

In terms of the length, patient experience leaders who participated in the report said it should be cut because many patients have complained it’s too long. The survey is currently 27 questions. (See p. 18 for a related story on the evolution of the chief experience officer.)

The hospital groups also expressed concern that some segments of the population are likely excluded from participating in the survey because of literacy challenges or housing instability. For instance, experience leaders participating in the report said patients who don’t speak English struggle to answer the questions even when they are translated into their own language. Versions of the HCAHPS survey are available in other languages and the report calls for reevaluating how those questions are asked.

“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,” said Dr. Bruce Siegel, CEO of America’s Essential Hospitals, which participated in the report.

Finally, there are key aspects of care currently missing from the survey, the report said. The hospital groups would like to see the HCAHPS survey address care transitions, post-discharge experience, comprehension of care plan, and emotional and physical sense of safety.

They would also like an option for patients to give feedback in their own words much like how reviews are given on websites like Yelp. Patient experience leaders said open responses from patients will give them a better sense of the quality of care provided.

“Updating and improving the HCAHPS survey could have a major impact on improving care,” Kahn added.

The other hospital groups participating in the report are the Association of American Medical Colleges and the Catholic Health Association. ●

The HCAHPS survey can now only be completed through mail or over the phone, which has likely contributed to the steadily declining response rates.