In 2008, the federal government began publicly reporting patient satisfaction scores for U.S. hospitals. They’ve been a treasure trove for reporters ever since.
A big plus of these measures is that more than 90% of eligible hospitals participate in the federal survey, called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS, pronounced “h-caps”). Its standardized format enables valid hospital-to-hospital comparisons regionally and nationally.
About the survey
The 29-question survey goes to random patients within five weeks of the day they are discharged. It’s available in seven languages. In January 2022, 4,489 hospitals reported HCAHPS scores based on 1.9 million completed surveys, according to a government fact sheet.
Questions cover eight areas of care: communication by doctors, communication by nurses, responsiveness of staff, communication about medications, cleanliness, quietness, discharge information and transition to post-hospital care. Patients are also asked to rate their stay on a scale of zero to 10 and indicate whether they’d recommend the hospital to family and friends.
Several changes designed to boost response rates are coming in 2025. They include expanding the response period from 42 to 49 days, adding online surveys to the existing mail and phone options, allowing patients’ proxies to complete the survey, and requiring hospitals to ask about a patient’s preferred language and provide a Spanish form if needed. These steps are described in the Federal Register.
Where to find the data
Scores are publicly reported quarterly via CMS’s Care Compare tool. You can also download national datasets.
Where to find more details
The latest information about HCAHPS is available on a website maintained by the Health Services Advisory Group, a unit of CMS’s Agency for Healthcare Research and Quality (AHRQ) that oversees survey development and analysis.
Other web pages provide an overview on how survey data are collected and used and explain how Medicare rewards good results via the Hospital Value Based Purchasing (VBP) Program.
Limitations to keep in mind
Factors such as failing to listen to a patient’s problems or poorly communicating discharge instructions, can contribute to medical errors that cause real harm. Still, patient satisfaction measures may or may not always align with clinical quality indicators such as mortality and readmission.
To reduce potential bias, HCAHPS scores are adjusted for response mode and patient mix before public reporting.
But keep in mind that there are other potential sources of bias. For example, patients who opt to respond might not reflect the patient population as a whole — a problem known as response bias. Factors like age, education and health literacy can affect response rates.
Cultural and language differences, access to technology and how well patients remember their experiences are other factors that might influence scores.
Story ideas
Dozens of news stories have been written based on HCAHPS. Here are a few recent examples.
- Fierce Healthcare covered a study showing that patient satisfaction dipped industry-wide during the COVID-19 pandemic, particularly in cleanliness and staff responsiveness.
- NPR reported that Veterans Affairs (VA) hospitals have higher patient satisfaction scores than private hospitals even though private care costs the VA more.
- The Philadelphia Inquirer highlighted the below-average cleanliness of the city’s world-class hospitals, including a list of 10 hospitals where less than 60% of patients reported rooms as “always” clean.
In reporting his story on hospital cleanliness, Inquirer health reporter Abraham Gutman said via email that “it was nice to have such a strong survey instrument to lean on, without (hospital officials) being able to dismiss it out of hand.”
Most of the “gross encounters” he heard about turned out to be pretty benign, Gutman added, but “it affirmed that readers care about these types of experience metrics, and that there is a service element in making it accessible on a regional basis.”
