Healthcare News & Insights

Patient satisfaction surveys: 5 changes CMS must consider

For years, hospitals have been judged on their performance in patient satisfaction surveys – particularly the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey from the Centers for Medicare & Medicaid Services (CMS). 

However, the HCAHPS survey has its flaws, and several hospital associations and groups are encouraging the feds to update it soon.

A new report from the American Hospital Association, the Federation of American Hospitals, America’s Essential Hospitals, the Catholic Health Association of the United States and the Association of American Medical Colleges lays out exactly what must be done to improve the survey.

The HCAHPS survey has only undergone minor tweaks since it was first given to patients in 2008 – the most recent being the removal of several questions asking about pain management (in part because facilities reported feeling pressure to overprescribe opioids to boost their rankings in this category).

Care practices have changed significantly in the past decade. The current HCAHPS survey doesn’t necessarily reflect that, so the report proposes a major overhaul to the survey and how it’s administered to patients.

Best updates to survey

Researchers spoke to experts at hospitals and health systems tasked with improving the patient experience to get their insight. According to their feedback, five key elements need to be updated in the HCAHPS survey:

  1. Offer a digital option. Response to the HCAHPS survey has been steadily declining over the years (from 33% in its first year to 26% in 2017). Allowing patients to fill out the survey online instead of having them complete a paper form may be more convenient and encourage more people to respond – which will give hospitals a more accurate picture of their patient experience. There’s good news on this front: CMS is already considering creating an online patient satisfaction survey, and if it gets funding, it’ll test out a web version of the HCAHPS survey soon.
  2. Shorten the survey. Right now, the HCAHPS survey consists of 27 questions, and facilities have the option to include additional questions about elements specific to their hospitals. Patients often get intimidated by the amount of questions, which can cause them to not complete the survey. If the feds reduced the survey’s length, it would give hospitals the chance to ask specific questions about individual stays and encounters without overwhelming patients.
  3. Take care delivery changes into account. Due to federal mandates and payor requirements, hospitals have placed a significant focus on providing patients with high-quality care at a lower cost in the past few years. But current HCAHPS surveys don’t include detailed questions that allow patients to let hospitals know whether they’re meeting those goals. Areas that could be expanded on in the survey include how well the care team worked together during the hospital stay and the effectiveness of the patient’s care plan (along with how easily it was understood by patients and families).
  4. Revamp the questions discussing care transitions and post-discharge planning. Improving the discharge process is critical to a patient’s recovery (and preventing readmissions). However, the questions on the HCAHPS survey about discharge planning are somewhat ambiguous, so patients may interpret how to answer them differently than the survey intends. Also, they aren’t designed to fully measure whether patients understood their post-discharge care plan or their discharge summary – a key element that impacts their health outcomes.
  5. Evaluate the survey on a regular basis. CMS should commit to periodically reviewing the questions on the HCAHPS survey to make sure they’re accurate and in line with current healthcare practices. The review should be based on feedback from stakeholders as well as any trends that may impact its results.

These updates, researchers said, will provide hospitals with more actionable information they can use to evaluate and improve their facility’s performance.

Time will tell whether some or all these changes are incorporated into future patient satisfaction surveys. We’ll keep you posted.

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