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Patient satisfaction survey needs to be overhauled, hospital groups say

Patient response rates have been declining over the years; the response rate was 33% in 2008 but just 26% in 2017.

Jeff Lagasse, Associate Editor

The American Hospital Association has joined the Federation of American Hospitals and three other hospital groups in calling for an overhaul to the patient experience survey that has been administered by the Centers for Medicare and Medicaid Services since 2007.

The groups contend that the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, is outdated, citing changes in care that have taken place on hospitals over the past decade-plus.

CMS, for its part, has sought public feedback on ways to improve the survey, and plans to seek feedback from patients on the issue later this year. HCAHPS is a 32-question survey administered primarily through mail and phone, and CMS uses the results to compare for value-based purchasing. Reimbursement rates are partially determined by the results.

Patient response rates have been declining over the years. The response rate was 33% in 2008 but just 26% in 2017, a trend that held steady across hospitals large and small, urban and rural.


The hospital groups cited social determinants of health as one reason to overhaul the survey. Social determinants, which can include everything from lack of literacy to housing and transportation instability, should be factored into the survey results, they said. This would help to engender a level playing field when comparing hospitals.

Patient experience leaders, or PELS, added their voices to the chorus, saying some of the topics covered in the survey inadequately address things like efficiency and teamwork among staff members.

The groups also said some aspects of care are missing from the survey, such as post-discharge experience, care transitions and comprehensive care plans.

The report advanced a number of recommendations for improving HCAHPS, such as adding an electronic delivery option for the survey, whether it be email, an app or a website.

The 32-question survey is also too long and should be shortened, the hospital groups said,and some of the questions are in need of an overhaul. Currently, the questions fail to address value-based care, evolving patient priorities and healthcare technology, and also fails to address the modernization of transitional care post-discharge.

A periodic re-evaluation of the survey would help to keep it modern and relevant, the groups said.

The Association of American Medical Colleges, America's Essential Hospitals and the Catholic Health Association were the other hospital groups included in the report.


Reimbursement rates for hospitals are partially determined by HCAHPS survey results, with underperformers relative to their peers receiving reimbursement cuts. CMS has expressed openness to changing the survey and periodically seeks public feedback on various initiatives.

Twitter: @JELagasse

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