What are HCAHPS survey questions?

Shortly after discharge from the hospital, patients are asked a series of questions about their experience. This is known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Some 4,000 U.S. hospitals participate in the surveys each year, gathering about 3 million patient perspectives.

The data from the surveys is used to create objective hospital reviews on the consumer-focused Hospital Compare website. These HCAHPS survey questions are updated regularly to improve the quality and accuracy of the aggregated reviews.

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How many HCAHPS questions are there, and what are they about?

Since HCAHPS was first introduced in 2006, the number of questions has fluctuated. In 2012 there were 27 questions; that grew to 32 in 2019. Four questions have been added to the 2020–2021 survey.

Despite the changes over the years, the theme of the HCAHPS survey has remained similar. There are eight domains in the HCAHPS 2020 survey. Each domain encompasses a different aspect of the patient’s experience with the hospital, with the exception of the final section, which asks the patient demographic questions for analytical purposes during the processing stage.

The eight domains of the HCAHPS survey questions are

  1. Your care from nurses
  2. Your care from doctors
  3. The hospital environment
  4. Your experiences in this hospital
  5. When you left the hospital
  6. Overall rating of hospital
  7. Understanding your care when you left the hospital
  8. About you

How are HCAHPS survey questions administered?

In 2018–2019 about 27 percent of outpatients responded to the HCAHPS survey, down from 33 percent in 2008. The Centers for Medicare and Medicaid Services (CMS) has linked the decline in responses to continuing reliance on mail and telephones to conduct the survey.

In 2019 the CMS recommended using electronic surveys to improve patient participation. Electronic HCAHPS surveys now complement the traditional phone, email, mail with telephone follow-up, or interactive voice recognition methods of data gathering.

There are a few major benefits and considerations for hospitals thinking about deploying electronic HCAHPS surveys. Electronic HCAHPS surveys are faster at gathering data than mail and phone surveys, and likelier to reach more patients. Hospitals can contract with a CMS-approved vendor to conduct HCAHPS surveys or conduct the survey on their own, if they receive approval from CMS to do so.

Regulations for HCAHPS surveys require vendors and hospitals to use the most recent questions. They also need to comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which dictates how patient information must be protected.

Who can I give the HCAHPS survey to and when?

HCAHPS surveys are administered to a random sample of patients, but not all patients are eligible to participate in HCAHPS surveys. There are certain requirements and protocols about who can be given an HCAHPS survey and when. 

Only patients who are admitted to the hospital for medical treatment are surveyed. Patients who are treated and released from the emergency room, patients who receive same-day surgery, and psychiatric patients aren’t surveyed. Although HCAHPS is organized by the CMS, participants don’t have to be Medicare patients.

There are a number of other protocols for administering HCAHPS surveys:

  • Patients must be surveyed within six weeks after their discharge.
  • HCAHPS surveys must be made available in English, Spanish, Chinese, Russian, Vietnamese, and Portuguese.
  • Vendors or hospitals may make multiple attempts to contact patients for a response.
  • Hospitals must collect surveys throughout the month.
  • Hospitals must collect 300 surveys per year.

HCAHPS Quality Assurance Guidelines for sampling, data collection, and submission can be found here.

The HCAHPS ethos

While the questions have changed slightly over the years, the ethos and aim of the HCAHPS survey and Hospital Compare website have remained the same. The goal is to give patients more control by creating a transparent process that allows them to compare reviews of hospitals, then make an informed choice as a consumer. This process challenges hospitals to raise their standards of care to world-class levels and always include the patient’s perspective in their care.

This article is originally published on May 29, 2020, and updated on Oct 05, 2021.

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