Modernizing the HCAHPS Survey

Executive Summary

The patient’s health care experience is considered one indicator of quality of care. Patient experiences with care received at hospitals have been captured and publicly reported at a national level since 2008 via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey consists of 32 questions focused mainly on patients’ experiences with the care they received during admission.

Public reporting of the HCAHPS survey enables consumers to make informed health care decisions, including the hospital they choose. The HCAHPS survey also uses patient experience as a measurement for value-based payments hospitals receive through federal programs.

We interviewed hospital and health system patient experience leaders (PELs) to gather their insights into the effectiveness of the HCAHPS survey in capturing patient experience. This paper will examine whether the current HCAHPS survey needs updating following the many changes and advancements that have happened in health care over the last 10 years since it was first implemented.

We found that PELs strongly support patient experience measurement and its use as an indicator of quality. However, there is wide consensus among PELs on the need to modernize the HCAHPS survey to reflect the changes in health care delivery and information technology and the shift in patient expectations. This paper delves into a variety of recommendations derived by PELs across different types of hospitals and health systems for modernizing the HCAHPS survey.

Key Findings

1. 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 data.
2. 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.
3. Topics Covered Are Important but Incomplete. PELs found that eight of the 27 core questions were important to keep. 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.
4. 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.
5. 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

1. Add a digital mode of delivery to existing modalities;
2. Shorten survey;
3. 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;
4. Reframe the care transitions and discharge planning sections of the HCAHPS survey; and
5. Periodically re-evaluate the HCAHPS survey.

Read the entire report by clicking on the link below.