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By Monica E. Oss

October 3, 2012

October 1 was a big day for hospitals. Going forward, the Centers for Medicare and Medicaid Services (CMS) will withhold 1% of Medicare payments to the lowest performing hospitals as part of the Value-Based Purchasing (VBP) program (see CMS Value-Based Purchasing to Reward Hospitals for Performance ). With the start of the VBP program, one issue that has raised a number of questions from readers is – how CMS is measuring the “consumer experience”?

In the Medicare Value-Based Purchasing program, which was created as a provision of the Patient Protection and Affordable Care Act, 70% of hospital evaluations are based on performance metrics and 30% are based on consumer satisfaction. The consumer satisfaction part of the score is determined using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

This survey tool was developed by CMS in partnership with the Agency for Healthcare Research and Quality (AHRQ), and endorsed by the National Quality Forum (NQF). The HCAHPS survey asks patients 27 questions about their care in eight areas:

  1. Communication with doctors

  2. Communication with nurses

  3. Responsiveness of hospital staff

  4. Pain management

  5. Communication about medicines

  6. Discharge information

  7. Cleanliness of the hospital environment

  8. Quietness of the hospital environment

The HCAHPS survey also measures patients’ overall rating of the hospital (on a scale of 0 to 10) and their willingness to recommend it. (To review the survey questions in full detail, see HCAHPS survey .)

There has been a lot of questions about how the survey itself is conducted:

  • Which patients are surveyed? The survey is conducted with a random sample of adult inpatients from medical, surgical and maternity care service lines between 48 hours and six weeks after discharge.

  • How is the survey conducted? The survey can be conducted using either mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR)

  • Who administers the survey? Some hospitals collect their own data, while others use approved survey vendors.

  • How many surveys must a hospital conduct? The targeted number of completed surveys is a minimum of 300 in any 12-month period, with a requirement that patients are surveyed during each month of the year (so, for example, you could not survey all 300 patients in the month of December).

The federal Department of Health & Human Services collects the survey data quarterly (for a collection schedule, see Data Collection Periods) then combines patients’ responses into 10 categories and calculates a composite score. CMS then reports the results on the website at Hospital Compare. This is what consumers see when using the tool:

While there has been some criticism that this represents just another group of numbers that either the public won’t care about, or that hospitals can easily manipulate (facilities that choose to self report, in theory, have the ability conveniently remove survey results they don’t want). Either way, monitoring the public’s understanding of these comparisons is another important tool for facilities looking to watch their performance, and their public image.

Monica E. Oss
Chief Executive Officer, OPEN MINDS

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