I am grateful to Centers for Medicare and Medicaid Services (CMS) for their tremendous impact on the movement of patient experience in healthcare – but it’s time to modernize the program.

Prior to the advent of HCAHPS (hospital consumer assessment of healthcare providers and systems) in 2007, the concept of experience in healthcare was an afterthought on the periphery of healthcare strategy. Thank you CMS for the push we all needed to refocus on the people we serve and provide a mechanism to elevate their voices to the table.

The industry that served patients and families finally began to think about their consumers in a strategic way and design their strategies to serve the people that mattered most. For me, it’s been delightful to reconnect clinicians to the reason they went into healthcare, and invigorating to engage executive leaders on driving patient-centric strategy.

However, it is time to bring the program into the 21st century.

Out of Date Data that is Not Representative

Since July 2007, hospitals have been required to collect, submit, and publicly report patient satisfaction surveys through HCAHPS in order to receive their full Medicare reimbursement.

Unfortunately, HCAHPS surveys can only be administered through one of the following methods:

  • Mail only
  • Telephone only
  • Mail with telephone follow-up
  • Active Interactive Voice Response (IVR)

Not only do these traditional survey methods create an excessive administration burden for providers [1], because the methodology only permits patients to be surveyed between 48 hours and six weeks after discharge,[2] but results are retrospective and delay the possibility for intervention and improvement.

Additionally, survey responses don’t fully represent the populations we serve. Often the cost for traditional survey methods restrict sampling, resulting in less data delivered in a timely manner to make meaningful patient experience decisions. A healthcare organization that sees 250,000 patients per year may have to make strategic decisions on feedback from fewer than 2,000 surveys.[3]

As Chip Kahn and Claudia Salzberg note in their recent Health Affairs blog ‘The Next Generation of Measuring Patient Experience’[4];

“Technology has changed dramatically since 2008. The same year that HCAHPS scores were first publicly reported, the Apple App Store debuted and people were rushing to buy the first touch-screen BlackBerry. Also in 2008, only 9 percent of non-federal acute care hospitals had adopted a basic Electronic Health Records (EHR). By 2017 that number jumped to a staggering 95 percent. Today, more than 80 percent of U.S. consumers shop online and 50 percent rely on online reviews to inform their purchases. In addition, businesses have access to consumer feedback in real-time through social media, allowing them to react immediately and improve customer service. This has now become a consumer expectation that extends into health care.”

CMS was successful in its original intent. Twelve years later, healthcare providers are measuring and assessing the needs of the people they serve as part of their strategy.  We need CMS to continue to evolve and approve modern channels for capturing feedback that today’s population utilizes.

Healthcare Experience Management is Ready for the Digital Age

Earlier this year, CMS invited comments on the proposed collection of information related to Testing of Web Survey Design and Administration for CMS Experience of Care Surveys[5].  I am encouraged to see CMS exploring digital delivery of patient experience surveys, and supporting the vision to collect quality data “using more innovative, efficient, and analytically powerful modes of data collection.”

However, I’m concerned that the 2-year testing window for digital tools is really unnecessary and inhibits the pressing need for the voice of patients and families to be heard.  We’ve seen widespread adoption and usage of digital tools by all patient populations –especially seniors and even vulnerable populations.

Vulnerable Populations Have Access to Technology

CMS needs to review the latest studies on internet and smartphone utilization by older, less educated, poorer, and minority populations. Unfortunately, CMS is citing studies which are at best 3 years old and, at worst, 10 years old!

CMS itself has previously pointed out the persistent myth of low technology use among seniors.

One recent CMS blog post by Seema Verna says: “Sadly, this type of ageism isn’t anything new. But it is inaccurate. CMS research has demonstrated repeatedly that many people with Medicare own smartphones and tablets, download apps, and use them all the time.”[6]

The fact is there has been a drastic increase in internet and smartphone use by seniors.

According to Pew Research Center’s 2019 data on internet and broadband usage [7], 73% of adults aged 65 and older use the internet. That’s double the usage since 2008 – and it continues to grow.

That same study notes there is little to no variation in usage in white, black, and Hispanic populations. Digital tools have proven more effective in reaching vulnerable populations, which are nearly impossible to reach via traditional survey methods.  For example, those who experience housing insecurity often have a smartphone device but not a stable mailing address or phone number.

2022 is far too long to wait to digitize the existing paper- and telephone-based survey methods that are hampering efforts to improve patient experience capture. CMS needs to consult with modern technology providers to shorten the review timeframe.

Time for Shorter HCAHPS Surveys

It’s not just the survey distribution mechanism that needs to reflect current norms – the HCAHPS survey itself needs to be updated.

The current HCAHPS survey includes 32 questions.  It was last reviewed and evaluated 15 years ago.  In a recent edition of Modern Healthcare,[8] Maria Castellucci explored CMS’ request for approval to collect feedback on possible changes to HCAHPS and the feedback from hospital leaders across the country:

“Hospital quality and patient-experience leaders agree it’s time for CMS to take a fresh look at the survey. Hospital leaders argue that an electronic version would increase response rates and the timeliness of results.”

It is time to take a fresh look and make sure the survey is relevant to today’s healthcare consumers.  We need HCAHPS to collect information that truly allows providers to improve care delivery on behalf of patients and families.

Remove the Administration Burden and Focus on Experience

By reducing the HCAHPS administrative burden, hospitals, administrators and clinicians can genuinely focus on improving the healthcare experience for patients and families.

Shortening the survey and modernizing distribution will spur competition among survey vendors, sparking innovation that will ultimately benefit patients and providers.

Here’s to a modern patient experience survey tool that works best for both healthcare providers and patients alike!

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[1] Health Leaders Media. “AHA Objects to New Patient Experience Surveys.” March 28, 2013

[2] Chilmark Research LLC, “Capturing Patient Experience: Current Challenges & Future Needs.” June 2018.

[3] Ibid

[4] https://www.healthaffairs.org/do/10.1377/hblog20190307.766083/full/

[5] https://www.federalregister.gov/documents/2019/01/31/2019-00433/agency-information-collection-activities-proposed-collection-comment-request

[6] CMS Blog, “Empowering Patients and Unleashing Innovation: eMedicare for Today and Future Generations.” March 1, 2019. https://www.cms.gov/blog/empowering-patients-and-unleashing-innovation-emedicare-today-and-future-generations

[7] https://www.pewinternet.org/fact-sheet/internet-broadband/

[8] https://www.modernhealthcare.com/safety-quality/cms-looks-revising-hcahps-survey