March 24, 2016
In response to what they perceive as “misuses” and “misperceptions” of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), representatives from the Centers for Medicare and Medicaid Services (CMS) have sought to clarify the value of the survey for aiding hospitals’ insights about the patient experience in order to promote improved quality of care.
The HCAHPS is the first national, standardized, publicly reported survey to collect data of patients' perspectives of their hospital care experiences.1 Mandated by the Centers for Medicaid and Medicare (CMS), the development of the HCAHPS was shaped by three overarching goals: (1) to produce objective and meaningful data about patients’ perspectives of care; (2) to create new incentives for hospitals to improve quality of care; and (3) to enhance accountability by increasing transparency.
HCAHPS utilizes 11 measures that allow fair comparisons of patient experiences in the following key areas:
- how well nurses and physicians communicate with patients;
- how responsive hospital staff are to patients’ needs;
- how well hospital staff help patients manage pain;
- how well the staff communicates with patients about new medicines;
- whether key information is provided at discharge;
- how smoothly the transition to the post-hospital setting is made;
- how clean and quiet are the patients’ rooms;
- the patient’s overall rating of the hospital; and
- whether the patient would recommend the hospital.
After hospitals administer the survey, CMS validates, analyzes, and reports the results.
The HCAHPS survey has provided many interesting insights thus far. For example, hospitals that provide better patient experiences also have better adherence to clinical guidelines and show lower risk-adjusted mortality rates and lower readmission rates.
Still, the authors urge hospitals to use the survey responsibly and for the purpose in which it was designed—to assess the “entire hospital experience and culture of patient-centeredness.” They cite instances of hospitals using the survey to compare, assess, and incentivize individual physicians, nurses, and other hospital staff as examples of misuse. Additionally, the authors sought to dispel any misinformation about the incentives created through the use of the survey; in particular, they cited the claim that HCAHPS compels clinicians to prescribe prescription opioids. The authors state, “There is no empirical evidence that failing to prescribe opioids lowers a hospital’s HCAHPS scores.” In response to the criticism, CMS currently exploring how best to measure patient experience in the area of pain control.