Updated metrics of patient experience are long overdue


Well over a decade ago, the way we measure patient experience was transformed when the HCAHPS survey was launched.

Hospitals have been measuring patient experience using a range of tools with different providers for decades. With the advent in 2006 of HCAHPS, which is implemented by CMS, a standardized tool was used for the first time across the country. The results have been made public to allow consumers to compare organizations against each other. The questions were asked in a new format, emphasizing consistency of experience in key areas. The results were also used as part of CMS’s value-based purchasing program.

HCAHPS was a game changer. It elevated the patient experience as a fundamental measure of the quality of healthcare. Its standardized nature ensured that results were fed into payment structures and other quality programs ranging from US News & World Report hospital rankings to American Nurses Credentialing Center Magnet designation. The pervasiveness of its use as a baseline metric has also allowed organizations to focus more strategically on understanding and improving the patient experience. All of these have been important steps in elevating the patient experience in healthcare. HCAHPS helped take the PX enhancement from ‘nice to do’ to ‘must do’.

Fifteen years later, we have seen improvements in the patient experience. HCAHPS measurements continue to improve year over year in most categories. Studies have shown a correlation between HCAHPS results and better quality of care, as well as better financial performance of hospitals. A body of knowledge on how to significantly improve the patient experience has emerged. It’s a good race.

For many reasons, however, we are overdue for updates on how we measure the patient experience in our country. Here are a few of them.

First, HCAHPS is currently only administered through paper surveys. In 2021, it is anachronistic.

We live less and less on paper. Surveys must now be administered in several ways, including phone, email and SMS. Having only one option – paper – should be addressed as soon as possible, as response rates decline year by year. Paper surveys also make HCAHPS a lagging indicator at best. Real-time results are needed to ensure that PX measurements keep pace with other quality measurements used by hospitals at this time. Fortunately, CMS is currently testing new survey modes. It must be accelerated.

Second, questions should be updated with patient feedback. Current HCAHPS questions continue to be valuable because they focus on the most essential element of the patient experience: communication with providers and the team. But the patients and advisory boards I speak with say updates are needed. Some questions seem redundant. Other key elements appear to be missing, particularly with regard to the role of family members in the patient experience. It is time to review and update this important standardized tool.

The events of the past year make this matter urgent. COVID-19 and an awareness of health justice and equity issues have a wide impact, including on how we measure and understand the patient experience. Our measurement system needs to be updated to its core to ensure that we collect data on race, ethnicity, and other identity issues so that we can understand patient experience outcomes in a meaningful way. more complete and more in-depth. This must be done in concert with the redesign of the tools themselves. And, it must be done now.

Finally, HCAHPS only applies to adult inpatient experiences. Other CAHPS tools were created to measure experiences in the emergency department, outpatient surgery department, physician practice environments, and for pediatric experiences. CMS has said for years that these tools will also be officially promulgated nationally – but that has yet to happen. This resulted in confusion and a shift in survey tools used across the country. It is also time to “land the plane” on these tools. The patient experience is the entire continuum of care, not just episodes of hospitalization. It’s time to put in place a true national PX measurement system that builds on the legacy of HCAHPS.

There are many Patient Advocates and Patient Experience Leaders across the country who are ready and willing to contribute to this effort, both alongside CMS and also with our legislative and political leaders whose participation is. necessary to move this agenda forward. We’re here and ready to help.

It’s important to remember that patient experience surveys aren’t just about questions and statistics. Properly structured and delivered, they can be a powerful voice for patients and families to help us improve health care. The events of the past year and a half have brought us to a number of times when change is both necessary and possible. We should also take this opportunity to evolve the measurement of the patient experience.


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