Blog » HCAHPS Turns 10

HCAHPS Turns 10

Created Jun 30 2016, 08:00 PM by Lippincott Solutions
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey
  • reimbursement
  • Centers for Medicare & Medicaid Services
  • Patient satisfaction

Friday, July 1, 2016

This fall marks the 10th anniversary of the Centers for Medicare & Medicaid Services’ implementation of the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS for short. Every day, more than 8,400 patients use the standardized survey to provide feedback on their recent hospital stay. Those results are collected monthly, reported online quarterly for consumers to see, and even affect the Medicare reimbursement facilities receive for services.

Here’s a look at some HCAHPS (pronounced “H-caps”) basics, the survey’s impact on hospital revenue, and how hospitals might improve scores by taking a broader view of patient satisfaction.


Patient satisfaction surveys were around long before HCAHPS. But via HCAHPS, CMS standardized the patient satisfaction data being collected, allowing for objective and meaningful comparisons of hospitals for the first time.

The 32-item survey is administered via phone or mail to a random sample of adult inpatients between two days and six weeks after discharge. Although HCAHPS scores influence Medicare reimbursement, the survey is not restricted to Medicare patients.

At the survey’s core are 21 questions that ask patients how often during their stay they experienced a critical aspect of hospital care. Questions address the following aspects:

  • how well nurses and physicians communicate with patients,
  • the responsiveness of staff to patient needs,
  • how well staff help patients manage pain,
  • how well staff communicate with patients about new medicines,
  • whether key information is provided at discharge,
  • how well patients understand the care needed after leaving the hospital,
  • the cleanliness and quietness of patients’ rooms,
  • the respondent’s overall rating of the hospital, and
  • whether the patient would recommend the hospital to family and friends.


In addition to the public reporting of results, a hospital’s HCAHPS scores affect its reimbursement. Up to 2 percentage points of a hospital’s annual Medicare payment update are on the line, influenced by whether the facility reports results as well as their scores, explained healthcare consultant Constance Donovan, MPH, RN.  

“Also, in the new era of hospital value-based purchasing, how hospitals do on the survey accounts for how well they perform in the patient experience of care domain,” she added.

For fiscal year 2016, the patient experience of care domain accounts for one-quarter of a hospital’s total performance score.


Writing in Forbes, customer experience consultant Micah Solomon cautioned hospital leaders not to miss the forest for the trees when it comes to efforts to improve HCAHPS scores. In other words, don’t aim too narrowly for success by focusing too much on specific questions.

“A better approach is to look at the survey questions only as they fit within your broader attempt to create an overall experience of caring that will in turn translate into better responses on the individual assessment questions due to a positive ‘halo effect’,” he advised.

“The halo effect I’m referring to is the tendency of humans — including patients and their loved ones — to cut you slack when they have a generally positive impression of you, how a positive experience with you will spread in their minds (and in their survey responses) to areas where, literally speaking, your institution may not have been entirely up to snuff.”

For example, no room is “always” clean, Solomon observed. But if a patient’s overall memory of his stay is positive, he’s likely to grade more leniently on specific measures. On the other hand, a patient who considers her treatment poor is likely to be more literal in her responses.

Solomon’s suggestions for improving the patient experience and, consequently, HCAHPS scores, is comprehensive yet practically specific. They deserve to be read in their entirety, but here are a few to whet your appetite:

  • Stop giving off vibes of indifference. Providers loudly discussing vacations in earshot of sick patients, nurses resisting to make eye contact with families before clocking in, and even out-of-service vending machines are not the most effective ways to demonstrate care and concern.
  • Understand the patient experience. Solomon suggests walking on crutches from the parking garage to the front door, asking someone unfamiliar with the hospital to use the signs to take you on a tour, and even an annual “full bladder exercise” — which requires patient care staff to down a couple liters of water and then ponder call-button response times — to get a better grasp of a patient’s reality.
  • When patients complain, don’t rationalize; simply apologize. “Resolving patient issues means knowing how to apologize for service lapses pointed out by a patient,” he wrote. “It means getting rid of the defensiveness (or, at best: apathy) that tends to mar the healthcare industry when confronted by a patient upset with what she perceives to be a service gaffe.”

Doing right is a reward in itself. But do right rightly, and you may be rewarded with better HCAHPS scores, too.