What Is HCAHPS? Why Is It Important?


Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) usually refers to a survey created by the federal government. It is designed to measure how well hospitals are performing in the eyes of its patients. Generally speaking, it measures patient satisfaction. It’s pronounced “H-caps.”

This year marks the 10th anniversary of public reporting of HCAHPS scores. To celebrate, let’s answer some common questions about it with help from the Centers for Medicare and Medicaid Services’ (CMS) website as our source.

Why Do HCAHPS Scores Matter?

How patients rate hospitals can impact the hospital’s bottom line. Of the things hospitals are measured on, they can face financial incentives or penalties (up to 2 percentage points of their annual payment update) based on whether they report results and how they score in 10 areas. Also, in the new era of hospital Value-Based Purchasing, how hospitals do on the survey accounts for how well they perform in the patient experience of care domain.

What Are Hospitals Measured on?

According to CMS:
■ Nurse Communication (Question 1, Q2, Q3)
■ Doctor Communication (Q5, Q6, Q7)
■ Responsiveness of Hospital Staff (Q4, Q11)
■ Pain Management (Q13, Q14)
■ Communication About Medicines (Q16, Q17)
■ Discharge Information (Q19, Q20)
■ Cleanliness of Hospital Environment (Q8)
■ Quietness of Hospital Environment (Q9)
■ Overall Rating of Hospital (Q21)
■ Willingness to Recommend Hospital (Q22)

How Does the HCAHPS Survey Take Place?

Patients are surveyed by mail or phone. Hospitals can conduct the surveys themselves or hire an outside group to do it for them. The information is collected monthly and reported quarterly. 

How Can I Find Out How Well My Hospital Scores?

You can look up the HCAHPS scores of your local hospital and compare its performance to how hospitals are performing across your state and the country on the Hospital Compare website: http://www.hospitalcompare.hhs.gov 

How HCAHPS Holds Hospitals Accountable

The HCAHPS survey value lies in that it is a standardized measurement tool that makes it easy to compare one hospital to another and because the results are publically available. This type of transparency holds hospitals accountable.

To create the survey CMS partnered with the Agency for Healthcare Research and Quality (AHRQ).

According to them, there were three main goals for creating it were to:

1) “Produce comparable data on patients' perspectives of care that allows objective and meaningful comparisons among hospitals on topics that are important to consumers”

2) “Create incentives for hospitals to improve quality of care” because the results are available publicly

3) “Increase transparency and increase public accountability” because of public reporting

New for 2016

Medicare and Medicaid reimbursements have been influenced about how hospitals score on HCAHPS as a whole for inpatients. This year hospitals will also be held accountable for how well their emergency departments are performing. These scores will begin to affect reimbursements.

If you’d like more information on HCAHPS or talk about ways to help boost your Emergency Department’s scores, contact Donovan & Partners today. We bring to bear more than 20 years of experience in helping emergency departments assess opportunities and set up efficient and cost-effective processes to deliver quality care.

Centers for Medicare and Medicaid Services: “HCAHPS: Patients' Perspectives of Care Survey,”

“The HCAHPS Survey - Frequently Asked Questions.”

Tips to Set the Scene for Open Patient Communication

We’ve all heard the saying, “There is no such thing as a stupid question.” But how good of a job is your emergency department nursing and medical staff at making patients truly feel that way? Your patient satisfaction and HCAHPs scores are riding on it.

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Healthcare has become consumer driven. Patient satisfaction surveys ask patients if nurses and doctors care about them, if they were given the information they needed to get well, and whether they are likely to recommend your hospital to someone else. Reimbursement is dependent on the effectiveness of our communication and the effectiveness of our treatment.

Here are some tips to help your team in their communication with patients.

1) Make Eye Contact. To engage the patients and families try being mindful to look them in the eye and listen with a caring and warm attitude.  Recognize this first step is the most important in establishing a rapport and this rapport will most likely set flow for the patient’s entire experience.  

2) Use Your Senses. You want to develop a communication style that is adaptive to the situation and patient you’re working with. Look, listen and feel to understand what is being said and not being said. Empathy and acknowledging the patient’s well-being and comfort demonstrate respect.

3) Anticipate. When you listen to understand your patients and their families it helps you anticipate concerns they may have. This can be very comforting. Anticipating involves knowing customarily what, when, why care is a certain way (process) and then thinking about questions the patient might have about the process but be too intimidated to ask. Try making thoughtful remarks such as “Many patients what to know when the doctor will see you”. Then acknowledge that the doctor has several patients and follow-up with information on how quickly the doctor will see them.

4) Try a Different Delivery Style. Think about creating a relationship where patients feel comfortable talking to us. You can create this type of relationship if you understand how to initiate conversations using techniques called “appreciative inquiry or welcoming questions.” These open channels of communication between patients and caregivers. That’s so important because patients have information that is crucial to helping them get better.

Appreciative inquiry involves framing questions in a way that helps you gather relevant information, foster a give and take in communication, and encourage positive action as a result

Rather than just communicating in short questions or commands, it involves asking an open ended question around the topic you want to address. Then you can guide to conversation to impart important information.

This might be a communication tactic which is different than the informative caregiver mode of communication that you’re used to. It’s no secret nurses and doctors are busy caregivers, we often need to make “a long story short” -- get to the point quickly and with technical accuracy. But while that is perfectly OK and actually important in communication between one shift of nurses to the next or between nurses and doctors or PAs, this hospital-speak is sometimes lost on patients.

In addition to being confusing, it often doesn’t create relationships with patients and family that inspire open and effective communication. Patients can become intimidated and are reluctant to ask questions because their nurse or doctor has such urgency.

How to Use Appreciative Inquiry
Here’s an example you might use when talking to a patient before discharge:

“We have a lot of patients that come to the ED for migraines. Have you sought out help for them from the emergency department before?”

This sets the scene in an empathetic way. You appreciate their problem -- the migraine. You set them at ease by letting them know they are not alone in seeking help for their type of problem and don’t feel scolded for it.

If they answer “Yes, twice before,” you can share information that will direct them toward taking positive action going forward. For example, you could then say: “We know about this clinic where you can get help managing your migraines.”

5) Be patient. Keep in mind that when you try this type of approach you may get more questions from patients. For example, a question about how long they can expect their recovery to take might be something you automatically know. But with patients you can’t take for granted that this is common knowledge. Patients and family don’t know what they don’t know, and need guidance to help them ask the right questions and establish expectations.

Remember, there are no stupid questions. Questions are a good thing. It means the patient is tuned in. Asking questions can help them better understand what role they need to take in recovering. Having an ongoing conversation can help you provide the best care.

Being composed, acknowledging, listening to understand, being responsive, knowing, and caring has the potential to engage and create a rapport with the patient and their family which impacts their overall experience. Interestingly, these approaches to communication can increase understanding, focus and efficiency too.

If you’re interested in talking more about communication techniques or making appreciative inquiry something you practice in your ED, drop me a message. I’m happy to talk more about it with you.

Create a Culture of Carefulness and Communication

Last week I mentioned two ways you can boost your patient satisfaction scores. Here's one doctor's perspective on how upping her communication game helps her provide quality care to the patients he sees. It's a good read.

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Communication is another area that you can focus on to boost scores. Solid communication among emergency department staff is so important. It influences patients' care and perception of that care.

As she talks about, establishing solid communication at shift changes is key. She also offers his personal tips and tricks for how to do it. Additionally, I love the shout-outs to the nursing staff. Do you have any things that have helped you create a "culture of carefulness and communication" in your emergency department?

This blog has got me thinking. In my next post we'll take a deeper dive into polishing up communication in the emergency department.