The HCAHPS survey is designed to let patients rate their hospital based on their satisfaction with the care provided during an inpatient stay. The CG-CAHPS survey lets patients rate their outpatient doctor or group practice. CG-CAHPS stands for “Clinician and Group Consumer Assessment of Healthcare Providers and Systems”. The information is publicly reported on Medicare’s Physician Compare website. In my case, the CG-CAHPS for all of Ohio State University Department of Internal Medicine outpatient physicians is reported in aggregate. However, internally, we get reports from Press Ganey that allows us to drill down on individual practice sites.

Here are the questions on the GC-CAHPS survey:

  1. If this was a visit for an illness, injury, or condition for care you needed right away, did you get this appointment as soon as you thought you needed it?
    • Yes
    • No
  2. If this was a visit for a check-up or routine care, did you get this appointment as soon as you thought you needed?
    • Yes
    • No
  3. In the last 3 months, if you phoned this provider’s office with a medical question during regular office hours, how often did you get an answer to your medical question that same day?
    • Never
    • Sometimes
    • Usually
    • Always
  4. In the last 3 months if you phoned this providers office with a medical question after regular office hours, how often did you get an answer to your medical question as soon as you needed?
    • Never
    • Sometimes
    • Usually
    • Always
  5. In the last 3 months, if this provider ordered a blood test, x-ray, or other test, how often did someone from this provider’s office follow-up to give you the results?
    • Never
    • Sometimes
    • Usually
    • Always
  6. During this visit, did you see this provider within 15 minutes of your appointment time?
    • Yes
    • No
  7. During this visit, did this provider explain things in a way that was easy to understand?
    • Yes, definitely
    • Yes, somewhat
    • No
  8. During this visit, did the is provider listen carefully to you?
    • Yes, definitely
    • Yes, somewhat
    • No
  9. During this visit, if you talked to this provider about any health questions or concerns, did this provider give you easy to understand information about health questions or concerns?
    • Yes, definitely
    • Yes, somewhat
    • No
  10. During this visit did this provider seem to know the important information about your medical history?
    • Yes, definitely
    • Yes, somewhat
    • No
  11. During this visit, did this provider have your medical records?
    • Yes
    • No
  12. During this visit, did this provider show respect for what you had to say?
    • Yes, definitely
    • Yes, somewhat
    • No
  13. During this visit, did this provider spend enough time with you?
    • Yes, definitely
    • Yes, somewhat
    • No
  14. Using any number from 1 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
  15. Would you recommend this provider’s office to your family and friends?
    • Yes, definitely
    • Yes, somewhat
    • No
  16. During this visit, were clerks and receptionists at this provider’s office as helpful as you thought they should be?
    • Yes, definitely,
    • Yes, somewhat
    • No
  17. During this visit, did the clerks and receptionists treat you with courtesy and respect?
    • Yes, definitely
    • Yes, somewhat
    • No
  18. In the last 3 months, if you took any prescription medications, how often did you and anyone on your health team talk about all the prescriptions medicines you were taking?
    • Never
    • Sometimes
    • Usually
    • Always

There are additional questions about the patient’s demographics, education level, overall perception of health, and race.

The data is aggregated into different topics and then reported as the percent of patients rating that provider as “top box”. So, for example, in the case of question #17, the top box would be ratings of 9 or 10. Similar to the HCAHPS survey, the CG-CAHPS survey suffers from grade inflation. In our specific clinic location, 93.5% of patients rate us as top box, with either a 9 or 10 overall rating. You can see the average scores at the Agency for Healthcare Research and Quality website where you can see averages by region of the country, physician specialty, type of practice, etc.

Some of the questions can be misleading:

When a patient is seeing a consultant the, questions about whether the provider had your medical records is a reflection of whether the referring physician sent records – if the consultant did not receive records before the patient’s initial visit, they cannot request those records until after the patient has come for the office visit and signed a release form allowing that consultant to request outside records. Therefore, if the referring physician failed to send records, the consultant gets a bad rating for question #11.

Many lab tests can take 2-3 weeks before the results come back. If the GC-CAHPS survey is sent out 2 days after the office visit, the lab test results will not be available and so of course no one from the office will have contacted the patient with the results. You have been set up for failure on question #5.

A specialist is generally not going to talk with the patient about all of their prescription medications every visit. Lets face it, you don’t want your orthopedic surgeon talking with you about the inhalers your pulmonologist prescribed. Similarly, do you really expect your dermatologist, who you are seeing for a mole, to review with you every one of the 25 medications you are taking for heart failure, diabetes, and hypertension? You are going to take a hit on question #18.

Right now, the data is mainly just accumulating and being reported for large group practices (such as the OSU Department of Internal Medicine). I get my own personal patient satisfaction scores internally from our department. However, some health systems now publicly report individual physician scores from the CG-CAHPS (for example, University of Utah). For physicians who are aghast that this information could be made public, search yourself on the internet – you are already being ranked by your patients at websites such as Vitals, Angie’s List, and Healthgrades. That data is unfiltered and subject to error (for example, in Healthgrades, I am listed as a neurologist, not a pulmonologist).

So get ready, you’re being rated just like restaurants on Yelp or hotels on Trip Advisor.

March 14, 2017