Everything You Need to Know About HCAHPS

hcahps

#1

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This post will have ongoing updates to remain current as things change. Here’s a list of points for this article:

  • What are HCAHPS?
  • How are HCAHPS scores determined?
  • What is the inclusion/exclusion criteria for the HCAHPS survey?
  • What questions are on the HCAHPS survey?
  • What is Hospital Value-Based Purchasing (VBP)?
  • How much is withheld?

What are HCAHPS?

HCAHPS stands for the Hospital Consumer Assessment of Healthcare Providers and Systems. It is the government’s way to try to determine how well hospitals perform.

The Centers for Medicare & Medicaid Services (CMS) uses a quality domain score (QDS) to rank hospitals. As of 2017, the breakdown is as follows:

  • 25% – Patient and Caregiver-Centered Experience of Care/Care Coordination (HCAHPS scores)
  • 25% – Clinical Care (Outcomes)
  • 25% – Safety
  • 25% – Efficiency and Cost Reduction

How are HCAHPS scores determined?

Hospitalized patients are randomly selected to be surveyed after discharge. The results of the surveys are averaged to determine 25% of the hospital’s overall quality domain score.

What is the inclusion/exclusion criteria for the HCAHPS survey?

Not every hospitalized patient is eligible to receive the HCAHPS survey. According to the CMS, the following patient groups are ineligible to receive the HCAHPS survey as of 2017:

  • Newborn
  • Psychiatric
  • Substance abuse
  • Rehabilitation
  • Deceased
  • MS-DRG codes with no assigned type

Furthermore, these patient groups are also excluded from receiving HCAHPS surveys:

  • “No-Publicity” patients – Patients who request that they not be contacted (see below)
  • Court/Law enforcement patients (i.e., prisoners); this does not include patients residing in halfway houses
  • Patients with a foreign home address (the U.S. territories – Virgin Islands, Puerto Rico, Guam, American Samoa, and the Northern Mariana Islands are not considered foreign addresses and therefore, are not excluded)
  • Patients discharged to hospice care (hospice-home or hospice-medical facility)
  • Patients who are excluded because of state regulations
  • Patients discharged to nursing homes and skilled nursing facilities

After these exclusions, patients are randomly sampled to be sent the survey.

What questions are on the HCAHPS survey?

Patients that are deemed eligible to receive the HCAHPS survey will answer the following questions. The questions are all multiple choice with the majority of the response choices being rated on a scale of: Never, Sometimes, Usually, or Always. Here are the questions:

  1. During this hospital stay, how often did nurses treat you with courtesy and respect?
  2. During this hospital stay, how often did nurses listen carefully to you?
  3. During this hospital stay, how often did nurses explain things in a way you could understand?
  4. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
  5. During this hospital stay, how often did doctors treat you with courtesy and respect?
  6. During this hospital stay, how often did doctors listen carefully to you?
  7. During this hospital stay, how often did doctors explain things in a way you could understand?
  8. During this hospital stay, how often were your room and bathroom kept clean?
  9. During this hospital stay, how often was the area around your room quiet at night?
  10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan?
  11. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
  12. During this hospital stay, did you need medicine for pain?
  13. During this hospital stay, how often was your pain well controlled?
  14. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
  15. During this hospital stay, were you given any medicine that you had not taken before?
  16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
  17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
  18. After you left the hospital, did you go directly to your own home, to someone else’s home, or to another health facility?
  19. During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?
  20. During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?
  21. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?
  22. Would you recommend this hospital to your friends and family?
  23. During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left.
  24. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.
  25. When I left the hospital, I clearly understood the purpose for taking each of my medications.
  26. During this hospital stay, were you admitted to this hospital through the Emergency Room?
  27. In general, how would you rate your overall health?
  28. In general, how would you rate your overall mental or emotional health?
  29. What is the highest grade or level of school that you have completed?
  30. Are you of Spanish, Hispanic or Latino origin or descent?
  31. What is your race? Please choose one or more.
  32. What language do you mainly speak at home?

What is Hospital Value-Based Purchasing (VBP)

So you might be asking yourself, “Why do HCAHPS scores matter so much?” Recall earlier, that CMS has decided that HCAHPS are going to account for a massive 25% portion of a hospital’s QDS. CMS is keeping track and ranking hospitals across the nation according to their QDS.

Depending on the hospital’s individual QDS relative to the average QDS score across all hospitals, CMS will decide how much a hospital will be reimbursed (through Medicaid and Medicare) for the care they provide.

How much is withheld?

  • 2013: 1.00%
  • 2014: 1.25%
  • 2015: 1.50%
  • 2016: 1.75%
  • 2017: 2.00%
  • 2018 and subsequent FYs: 2.00%

Using this data, in 2017 and onward, if a hypothetical hospital billed for a total of $1B in annual services, they may lose up to $20M if they do poorly on QDS, which could potentially be purely HCAHPS driven since that portion makes up 25% of the QDS.

It is no surprise that hospitals are taking HCAHPS seriously because they can significantly impact their fiscal bottom line.

If patients are rating their hospital experiences poorly, it will have a massive negative effect on the hospital’s net score, and will likely cost the hospital millions of dollars in lost reimbursement.

If a hospital’s HCAHPS are higher than the average score, they will receive extra money for the amount billed. If the scores are lower, then they will not receive as much as the amount billed.

HCAHPS Suck!


The Entitlement Generation is Going to Murder Hospitals
#2

I wonder if HCAHPS are largely to blame for the opiate crisis in America. I’ve heard to increase scores, providers are being pressured by hospital admins to prescribe more opiates than medically necessary or indicated to “appease” patients. According to the CDC, physicians are a leading source of prescription opioids for the highest-risk users:


#3

I hate HCAHPS. It’s created a hotel culture where customer service and patient satisfaction are often prioritized over sound medical care.

  • Hospital A can perform 100 CABGs per year and have a 50% mortality rate, but 100% patient satisfaction.
  • Hospital B can perform 100 CABGs per year and have a 0% mortality rate, but 50% patient satisfaction.

In this example, Hospital A may be reimbursed more money from CMS because of higher patient satisfaction rates despite the fact that their outcomes are worse than Hospital B. Furthermore, Hospital B will actually lose money (basically giving it to Hospital A) by having better outcomes but worse satisfaction scores. This is ludicrous IMO.


#4

Thank God they don’t interview psych patients haha, can you imagine how screwed we’d be if they ever did?

TDO’d patient in with ETOH withdrawal: “This place is literally hell. I saw spiders the size of humans crawling on the ceiling, the staff didn’t give me all the drugs I wanted, I saw Satan himself outside my window (on the 3rd floor), and the food and cable channels sucked!”


#5

If we have to operate under the duress of HCAHPS, then I feel like psych and substance abuse diagnoses that are secondary should automatically result in disqualification. If a schizophrenic falls and breaks their hip and is admitted for a hip fracture, then their primary diagnosis is a fractured hip and not schizophrenia. They still have a secondary diagnosis of psych, but wouldn’t they now qualify to receive the HCAHPS survey?

Same goes for substance abuse patients, who no doubt will tank a score if they don’t get all the drugs in the pharmacy. I think we should have psychiatric evaluations of EVERY patient we admit, and if any diagnosis includes psych or substance abuse, then we should be able to disqualify these patients. This system would hopefully equalize hospitals with differing demographics such as rural vs urban hospitals. It would widdle the surveying down to patients who will be more likely to legitimately rate their experience without as much insane subjective bias.


#6

We always get asked, what more can we do to improve the hospital. I think the hospital is as good as it can get with the setup we have. Unless more staff magically appear, or the hospital teleports to a nicer location with nicer people, we’re never going to see a change. But nobody wants to hear this answer. Damn those pesky facts.


#7

Druggies have no business determining hospital reimbursement!


#8

I know what you mean. I’ve had patients who are impossible to please. I can do everything to help them, and it is never enough. They’re just mean people and sometimes there’s nothing you can do about it.


#9

Don’t take it personally. Unfortunately, there are unpleasant people everywhere, and if you let them get under your skin in this profession, then you’ll get burned out way too fast.


#11

They might as well go full out on the “hotel culture” and hire employees in all the obvious areas: Valets, room service, maids, concierge service, etc.

It sucks that they never do this and instead just add all these extra duties onto the laundry list of items that nursing is already responsible for, and then they complain if we don’t get everything done perfectly on time and if any mistakes are ever made. How are we supposed to keep up?

I heard that in Vanderbilt hospital in Tennesee, the housekeeping staff was cut back and they made nurses mop the floors to make up the lost ground. I don’t know about all of you, but I didn’t go to nursing school to mop floors and wait tables.


#12

Millions of dollars on the line possibly over bad tv channels and poorly cooked meals… yikes!


#13