Frequently Asked Questions on HCAHPS

Have questions about HCAHPS? You're not alone. There is a lot to understand when it comes to participating in the public reporting initiative. Here are the answers to some of the most frequently asked HCAHPS questions.

HCAHPS OVERVIEW

Q: What is HCAHPS?
A: HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. In the summer of 2002, the Centers for Medicare and Medicaid Services (CMS) asked the Agency for Healthcare Research and Quality (AHRQ) to develop an instrument to measure patient perceptions of care. This measurement would be used to publicly report hospital performance (quality of care as perceived by patients). The goal of this public reporting instrument, as stated by CMS, is to provide consumers with information that might be helpful in choosing a hospital. CMS has also stated that it should complement rather than compete with quality improvement instruments already being used by hospitals. Although the survey has changed significantly since 2002, its purpose remains the same.

Q: What is the HCAHPS questionnaire like?
A: Here is an overview of the survey:

• The instrument asks patients to rate the frequency of events during their care (never, sometimes, usually, always).
• The survey is organized under the following headings: Your Care from Nurses, Your Care from Doctors, Your Experiences in the Hospital, When You Left the Hospital, Overall Rating of the Hospital, About You.
• The survey questions will be reported in the following domains:
  • Communication with Doctors
  • Communication with Nurses
  • Responsiveness of Hospital Staff
  • Pain Control
  • Communication about Medicines
  • Cleanliness and Quiet of the Physical Environment
  • Discharge Information
• The instrument can be used either as a stand alone survey or embedded into an existing patient survey with the core HCAHPS questions at the beginning of the survey. The hospital can decide how many questions to add.
• Initially, the survey will only be available in English and Spanish.

Q: How much will it cost us to do HCAHPS?
A: Press Ganey will absorb all costs associated with setup, processing, reporting, and becoming an approved HCAHPS vendor. There will be no additional costs to Press Ganey clients except for the CMS-required second-wave mailing of HCAHPS questionnaires.

Q: I have heard that reimbursement will be tied to HCAHPS. Is that true?
A: On November 1, 2006 CMS issued a final rule regarding the Outpatient Prospective Payment System that was designed to promote higher quality in outpatient care. Although the rule is primarily related to the Outpatient Prospective Payment System, it also includes provisions for expanding the quality reporting requirements for hospital inpatient services and links submission of HCAHPS data - beginning with discharges in July of 2007 - to the hospital’s market basket update for the 2008 fiscal year. Hospitals that are subject to IPPS payment provisions (RHQDAPU-eligible "subsection (d) hospitals") must meet the new reporting requirements in order to receive their full IPPS annual payment update (APU) for fiscal year 2008. IPPS hospitals that fail to report the required quality measures (which include the HCAHPS patient perspective survey) could receive an APU that is reduced by 2.0 percentage points. Non-IPPS hospitals (e.g., critical access hospitals) can voluntarily participate in HCAHPS. However, neither participation nor non-participation in HCAHPS will affect the annual payment update of hospitals that are not subject to IPPS payment provisions.

HCAHPS TIMELINE

Q: What is the Dry Run?
A: Before the national implementation of HCAHPS, hospitals who will participate in the HCAHPS initiative are required to go through a Dry Run.

Q: Will the Dry Run data be publicly reported?
A: Dry Run data will not be publicly reported. The data will be submitted to CMS for quality checks and to ensure that all processes are running smoothly before participating in national implementation.

Q: Can I participate in the Dry Run but then decide not to participate in national implementation?
A: Yes. Participating in the Dry Run makes you eligible, but does not obligate you, to participate in national implementation.

Q: What if my hospital is not already participating in national implementation?
A: In order to meet CMS requirements and to achieve the full payment update in the 2008 fiscal year, you must be participating in the 2007 national implementation beginning with July 2007 discharges.

Hospitals that have not yet joined HCAHPS or participated in a Dry Run and wish to participate in HCAHPS must participate in the September 2007 Dry Run. This Dry Run is to include eligible discharges from the month of September 2007. Hospitals participating in the September 2007 Dry Run will continue to collect data for HCAHPS eligible discharges in October 2007 and forward. Participation in the September 2007 Dry Run will not qualify as meeting requirements for the fiscal year 2008 Annual Payment Update. Hospitals participating in this Dry Run must contract with an approved vendor.

Q: If I know I want to participate in the national Dry Run, what do I need to do to get started?
A: If you know that you would like to participate in the national Dry Run, let your Consultant know. We will set up your survey to prepare for Dry Run data collection.

Q: When will my national implementation data be transmitted to CMS?
A: Press Ganey will submit national implementation data on behalf of our clients every month starting in February 2007 to ensure compliance with CMS protocols.

ELIGIBLE HOSPITALS

Q: Which hospitals are eligible to participate in HCAHPS?
A: Hospitals that report clinical data to CMS are eligible to participate in HCAHPS. It is not intended to be used for pediatric hospitals, psychiatric hospitals, or other specialty hospitals.

Q: If HCAHPS is for general acute care hospitals, can you specify which types of specialty hospitals would be excluded from the HCAHPS process?
A: HCAHPS is designed for acute care hospitals. The majority of specialty hospitals (e.g., pediatric, psychiatric) are excluded. Any hospital that is reimbursed under the Inpatient Prospective Payment System and is eligible for the Annual Payment Update (referred to as RHQDAPU) will need to participate in HCAHPS in order to receive full reimbursement updates in FY 2008. If you are unsure if your hospital should participate in HCAHPS contact hcahps@azqio.sdps.org or call 1-888-884-4007.

SAMPLING

Q: What patients are eligible to receive an HCAHPS survey?
A: The survey is designed for all (not just Medicare) adult patients discharged from general acute care hospitals after an overnight stay. Patients to be excluded include: patients who are under 18, those who died in the hospital, patients discharged to hospice, patients who received psychiatric or rehabilitative services, prisoners, and patients with international addresses. Other allowable exclusions would include those required to comply with any state legislation.

Q: Do we have to send all eligible patient records to Press Ganey?
A: Yes, it is a CMS requirement designed to ensure that all eligible patient discharges are reported. You can not sample records before sending the files to Press Ganey. Per CMS guidelines, Press Ganey must be able to count the number of eligible discharges and attest to the randomness of the sample. All eligible records must be sent and all required fields must be populated in the upload (see InfoTurn Transmission Instructions for more information).

Q: Should patients who are discharged to another facility be mailed a survey at their home or at the other institution?
A: Vendors should attempt to contact all discharged patients at the home address/telephone number provided in the hospital?s administrative record.

Q: Can we sample once a year to fulfill the HCAHPS requirement?
A: No. In order to have your data publicly reported, you must have data for every month. Most hospitals will sample on an ongoing basis each month, just like your regular Press Ganey survey.

Q: How often should a patient receive a survey?
A: A patient should receive a survey for every inpatient stay. The only allowable exclusion is for a patient who has multiple stays in one calendar month.

Q: How many completed surveys do we need to have our data publicly reported?
A: A minimum of 300 completed surveys must be received over the course of 12 months. For the initial collection period during national implementation, you need 300 returns in a nine month period so that public reporting can take place after 10 months of data collection. This means that on average, 35 completed surveys should be collected during each of the first nine months.

Q: What happens if a hospital gets fewer than 300 HCAHPS returns - for instance if the number of completed surveys turns out to be 275 instead of 300?
A: Hospitals should be targeting to collect at least 300 completed HCAHPS surveys over a twelve month period, after the initial public reporting period of nine months (October 2006 through June 2007). For those hospitals that cannot collect 300 completed HCAHPS surveys, CMS plans to note on Hospital Compare that, for those hospitals, results are based on less than 100 completed surveys or between 100 and 299 completed HCAHPS surveys.

SURVEY ADMINISTRATION—MODE AND TIMING

Q: What methodologies are allowed for HCAHPS?
A: The survey can be administered via any of the following: two-wave mail survey, five-attempt phone survey, combined mail/phone survey, or Active Interactive Voice Response (Active IVR).

Q: When should the survey be sent to the patient and when does it need to be returned?
A: Surveys must be distributed between 48 hours and six weeks post discharge to be included. Data collection must close six weeks following the start of data collection for each respondent.

REPORTING

Q: When will National Implementation data be publicly reported?
A: The first public reporting of HCAHPS results will occur in March 2008. Hospital results for patients discharged between October 2006 and June 2007 will be displayed on the Hospital Compare website. Participating hospitals will receive a “preview report” of their results and will have the option, on this occasion, to suppress their results. CMS anticipates that hospital results will be presented in a fashion similar to that currently used for clinical quality measures.

Q: What will the data look like when they are publicly reported on the Hospital Compare Web site?
A: Report formats are currently being tested with consumers. It is anticipated that bar graphs will be used to note hospital performance. For composites and global items, the percent of responses in the top box (i.e., percent Always, 10, Yes, etc.) will be displayed. The entire distribution of responses may be also displayed. Consumers will have the ability to drill down for more information. Data will likely be reported in a fashion similar to clinical data on the Hospital Compare Web site (www.hospitalcompare.hhs.gov).

Q: Will there be peer groups or adjustments for hospital characteristics (e.g., size)?
A: Reports will provide a national and state norm. There will not be peer group comparisons or other adjustments on the Hospital Compare Web site. Press Ganey will provide comparative data for HCAHPS just as you are accustomed to receiving in your standard reports.

Q: I have heard discussions of patient-mix adjustment. What is that?
A: Patient-mix adjustment is a calculation to adjust a hospital’s results, based on patient and hospital demographics, to reflect what one would expect from a “typical” patient population. The intent of patient-mix adjustments is to make data comparable across different settings. The formula for patient-mix adjustment is currently being developed by CMS. CMS will apply patient-mix adjustments to a hospital’s data before it is publicly reported.