CMS Clarifies Oversight of HCAHPS in 2009, Releases Updated Scores

Heather Comak, April 16, 2009

CMS released its fifth quarterly update of patient satisfaction data late last month, one year after the first Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospitals that participated in the pilot test were made available to the public. This time around, scores from all hospitals that receive reimbursement through the inpatient prospective payment system have been included.

After the first round of the survey was released in March 2008, hospital leaders and staff members were unsure of the extent to which consumers would use the data available. It's since been shown that although some consumers have been looking at the data, they have not been using those data to choose where they receive care.

"I think it created apprehension initially because it was the first time that this type of information would be public," says Deirdre Mylod, PhD, vice president of the acute business division at Press Ganey, a vendor for administering the HCAHPS survey. "I think we've moved from apprehension clearly through to acceptance. Although patients have gone to the site, a fair amount of the research suggests that patients are not using the publicly available data—not just HCAHPS, but any of what's out there—to truly make decisions about their care."

The March release of HCAHPS scores represents survey data collected from patients discharged between July 1, 2007, and June 30, 2008. Although the survey questions have not changed since the initial survey was released, CMS has translated the survey into Chinese, Russian, and Vietnamese for 2009.

In the past 18 months, CMS has also increased its oversight of the guidelines surrounding HCAHPS, specifically about communicating with patients. Hospitals should not communicate with patients about the HCAHPS survey in a way that might affect their responses or diminish their likelihood of completing the survey.

This spring, the Agency for Healthcare Research and Quality (AHRQ) and CMS are collaborating on an HCAHPS chart book, says Carrie Brady, MA, JD, vice president of quality at Planetree, Inc., a nonprofit consulting company that helps hospitals focus on delivering patient-centered care. The book will provide hospitals with national benchmarks for each question that is asked on the HCAHPS survey. This differs from the data available at the Hospital Compare Web site, which show composite scores for each topic covered on the survey. Although hospitals could ask their vendors for benchmarks for each question, having national data offers a more complete picture.

"It'll be nice to have the full set of national data and be able to drill down into individual questions," says Brady. "Your comparative performance compared to a vendor pool, depending on the size of that pool, can tell you a different story than the national data will tell you."

Although the intent of releasing HCAHPS scores and making them available to the public was to give patients more options for choosing their care, the public scores have had a greater effect on the quality of care at hospitals around the country on the whole, says Mylod.

"CMS intended [HCAHPS] to be a public report measure for consumers," she says. "They also hoped it might spur quality improvement because of the fact of transparency. I think that, actually, the second thing has happened more than the first because consumers aren't using it to drive choice, but executives know that how they're doing is public. Clearly, there have been differences in the way people behave."

Press Ganey, a company that works with 42% of U.S. hospitals to help them improve care, analyzed the data coming out of the hospitals with which they consult from January 2007 through July 2008. During that time, large statistical increases were seen in patient satisfaction from the year-over-year data reported in May and June 2008, following the first release of HCAHPS data in March 2008. Press Ganey reported that during the 23 years it has been analyzing these types of data, this jump in patient satisfaction with inpatient care was the largest it had ever seen.

Additionally, CMS ran a large public ad campaign in major national newspapers during May 2008, publicizing the first release of scores. This resulted in a huge spike in visitors to the Hospital Compare Web site. In March 2008, just after the scores were released, about 2 million people visited the Web site. In June 2008, that number jumped to 12 million.

"There were jumps in patient satisfaction scores that clearly said to me that executives were paying attention, boards were paying attention," says Mylod. "The fact of transparency and the public report clearly drove changes in how hospitals behaved."

Brady says the improvements in patient satisfaction that CMS had hoped for are occurring, even if not as many patients as expected are choosing where they receive care based on HCAHPS scores.

"What has been the most compelling effect is that hospitals are more focused on the data," she says.

Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals. Contact Heather by e-mailing
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