The HCAHPS survey measures patient satisfaction with inpatient care. It is sent to patients after discharge with instructions to fill it out and mail it in a pre-paid envelope. The results are posted on the Medicare Hospital Compare website where you can see how your hospital performs compared to other hospitals in the same state and other hospitals nationwide. HCAHPS stands for “Hospital Consumer Assessment of Healthcare Providers and Systems”. The survey takes patients an average of 7 minutes to complete. The survey is sent out to a random sample of patients recently discharged from the hospital and can be sent anytime from 2 days to 6 weeks after discharge. The average response rate is usually around 32%. Here are the HCAHPS questions. The first 14 questions are answered by “Never“, “Sometimes“, “Usually“, or “Always“:

  1. During this hospital stay, how often did nurses treat you with courtesy and respect?
  2. During this hospital stay, how often did nurses listen carefully to you?
  3. During this hospital stay, how often did nurses explain things in a way you could understand?
  4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
  5. During this hospital stay, how often did the doctors treat you with courtesy and respect?
  6. During this hospital stay, how often did doctors listen carefully to you?
  7. During the hospital stay, how often did doctors explain things in a way you could understand?
  8. During this hospital stay, how often were your room and bathroom kept clean?
  9. During this hospital stay, how often was the area around your room quiet at night?
  10. During this hospital stay, how often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
  11. During this hospital stay, how often was your pain well controlled?
  12. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
  13. Before giving you any new medicine, how often did the hospital staff tell you what the medicine was for?
  14. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
  15. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
    • Yes
    • No
  16. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
    • Yes
    • No
  17. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?
  18. Would you recommend this hospital to your friends and family?
    • Definitely no
    • Probably no
    • Probably yes
    • Definitely yes
  19. During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.
    • Strongly disagree
    • Disagree
    • Agree
    • Strongly agree
  20. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
    • Strongly disagree
    • Disagree
    • Agree
    • Strongly agree
  21. When I left the hospital, I clearly understood the purpose for taking each of my medications.
    • Strongly disagree
    • Disagree
    • Agree
    • Strongly agree

There are also some other questions about the patient’s perception of their health, their race, their preferred language, and their education level. You can find the full HCAHPS survey here.

The Medicare Hospital Compare website takes these 21 questions and combines some of them into a total of 7 composite topics, 2 individual topics, and 2 global topics that are then reported on the website. The reported topics are:

  1. Nurse communication
  2. Doctor communication
  3. Responsiveness
  4. Pain management
  5. Communication about medications
  6. Discharge information
  7. Care transitions
  8. Cleanliness of hospital environment
  9. Quietness of hospital environment
  10. Hospital rating
  11. Willingness to recommend hospital

One of the problems with the HCAHPS survey is that it suffers from the same phenomenon that high school and college tests suffer from: grade inflation. So, for example, question #17 asks the patient to rate the hospital overall on a scale of 0-10. Medicare divides the answers in to “top box” (9 or 10), “middle box” (7 or 8), and “bottom box” (0-6). A score is calculated from the percent of patients rating the hospital in the top box (in other words, the percent of patients giving the hospital either a 9 or a 10). The average score nationwide is a 72 and the top 5% of hospitals have a score of 87 with the bottom 5% of hospitals having a score of 57. So, if your community is filled with people who think that on a 0-10 scale, 5 is average, your hospital is doomed. On the other hand, if your community is filled with people who think that 8 is average on a 1-10 scale, then you’re in good shape.

The data from all of the questions are then added to a number of other measures of hospital quality, such as mortality and readmission rate, to give a final star rating where hospitals are assigned an overall score of 1-5 stars. In December 2016, the distribution of star ratings for all hospitals in the U.S. is shown in this graph.

Medicare ties HCAHPS scores to hospital reimbursement. This fiscal year, 2% of a hospital’s Medicare payments are tied to HCAHPS so it motivates hospitals to get as high of a score as possible. At our hospital, I get a monthly analysis of our performance on each of the 11 HCAHPS topics and they can vary wildly from one month to another. There are all sorts of strategies used to improve HCAHPS scores including staff education and expansion of specialty services such as pain management services. There is also a lot of speculation about the best time to mail out the surveys – should you wait a few weeks after discharge so that the patient forgets about what the bathroom looked like? Or should you mail the survey out right away, 2 days after discharge before the patent gets their hospital bill?

Regardless, doing well on the HCAHPS survey is not just about improving patient care in your hospital but about improving the patient’s perception of care in your hospital.

March 10, 2017