Developing and
Implementing HCAHPS,
The first national, standardized, publicly reported
survey of patients perspectives of hospital care
~
AcademyHealth Research Meeting
Orlando, Florida
June 4, 2007
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William G. Lehrman, PhD1
Elizabeth Goldstein, PhD1
~
1 Centers
for Medicare & Medicaid Services (CMS)
Division of Consumer Assessment and Healthcare Surveys
7500 Security Boulevard, S-13-05
Baltimore, Maryland 21244-1850
2
Overview of Presentation

Purpose of HCAHPS

Content of HCAHPS

Development of HCAHPS

Implementation of HCAHPS

Impact of HCAHPS
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Name of Survey
®
• Formal name: CAHPS Hospital Survey
• Also known as:
– Hospital CAHPS® or
– HCAHPS
• Hospital Consumer Assessment of Healthcare
Providers and Systems
CAHPS® is a registered trademark of the Agency for Healthcare
Research and Quality (AHRQ), a U.S. Government agency.
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Purpose of HCAHPS
• Publicly report the patient’s perspective
of hospital care
• Provide new incentives for hospitals to
improve quality of care
• Enhance transparency and public
accountability in healthcare
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Method of HCAHPS
• Ask patients (survey)
• Collect in standardized, consistent manner
• Analyze and adjust data
• Publicly report with full accessibility
• Promote improvement in hospital care
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HCAHPS 101
• Short-term, acute care hospitals
– “General hospitals” (AHA)
• Excludes pediatric, psychiatric and specialty hospitals
• Eligible patients
–
–
–
–
Adult
Medical, surgical or maternity care
Overnight stay, or longer
Alive at discharge
• Survey after discharge
– Four modes of survey administration
– Standardized protocol
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Composition of Survey
HCAHPS contains 27 items:
• Items 1-22: Core of HCAHPS
• 18 substantive items
• 4 “screener” items
• 5 demographic items
• Survey may be either:
– Administered as a “stand-alone”, or
– Integrated with a hospital’s own patient satisfaction
survey
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HCAHPS Seven Domains/Composites
What patients/consumers want/need to know:
1. Communication with nurses
2. Communication with doctors
3. Responsiveness of hospital staff
4. Cleanliness and quietness of hospital room
5. Pain management
6. Communication about medicines
7. Discharge information
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HCAHPS Overall Ratings
HCAHPS also contains two individual items:
• ‘Overall rating of hospital’
• 0 to 10 scale
• ‘Recommend this hospital’
• Four point scale
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HCAHPS example: Communication with nurses
1. During this hospital stay, how often did nurses treat you with courtesy
and respect?
1�
2�
3�
4�
Never
Sometimes
Usually
Always
2. During this hospital stay, how often did nurses listen carefully to you?
1
2
3
4
�
�
�
�
Never
Sometimes
Usually
Always
3. During this hospital stay, how often did nurses explain things in a way
you could understand?
1
2
3
4
�
�
�
�
Never
Sometimes
Usually
Always
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Development of HCAHPS:
Research & Testing
• Call for measures (2002)
• Survey and item development (2002-2003)
• Cognitive testing, English & Spanish (2003)
• Three-State Pilot Test (2002-2003)
• Qualitative research with consumers (2004)
• Test public reporting format (2005-2007)
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Development of HCAHPS:
Approval & Endorsement
• Numerous Federal Register notices, with
public comment periods (2003–2006)
• NQF endorsement (May 2005)
– “National voluntary consensus standard”
• Abt Assoc. cost-benefit analysis (Oct. 2005)
• Final OMB approval (December 2005)
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Implementation of HCAHPS
• Training for hospitals and survey
vendors (February & April 2006; January & May 2007)
• Mode experiment
• “Dry Run”
(February – May 2006)
(April – June 2006; March 2007)
• National Implementation (Oct. 2006)
• HCAHPS – payment linkage in
FY2008 (announced November 2006; effective July 1, 2007)
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Implementation of HCAHPS
Hospital/Survey Vendor role: Data Collection
– Develop sampling frame of eligible
discharges
– Draw required sample
– Administer survey
– Submit HCAHPS data to data warehouse
– Adhere to Quality Assurance Guidelines
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Implementation of HCAHPS
Government Role: Support & Report
–
–
–
–
Provide training and technical assistance
Ensure integrity of data collection
Conduct Mode Experiment
Accumulate data from hospitals/survey
vendors
– Calculate and publicly report HCAHPS
results
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Implementation of HCAHPS: Future
• Public reporting linked to Annual
Payment Update (APU) (July 1, 2007)
• First public reporting of results on HHS’
Hospital Compare website (March 2008)
• Proposed linkage to
Pay-for-Performance (FY??)
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Impact of HCAHPS
Key actors:
•
•
•
•
•
Hospitals
Survey vendors
CMS
Payers
Patients & Consumers
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More information about HCAHPS
• Background, details, and reports:
www.hcahpsonline.org
• Publicly reported HCAHPS results:
www.hospitalcompare.hhs.gov
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Comments?
william.lehrman@cms.hhs.gov
— or —
elizabeth.goldstein@cms.hhs.gov
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HCAHPS in the Media.
Copyright, Pittsburgh Post-Gazette, 2007, all rights reserved. Reprinted with permission.
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