HCAHPS

HCAHPS / en Mon, 28 Apr 2025 01:38:47 -0500 Fri, 28 Feb 25 10:02:03 -0600 AHA Comments to MedPAC on Rural Medicare Beneficiary Cost-sharing /lettercomment/2025-02-28-aha-comments-medpac-rural-medicare-beneficiary-cost-sharing February 28, 2025 Michael Chernew, Ph.D. Chairman Medicare Payment Advisory Commission 425 I Street, NW, Suite 701 Washington, D.C. 20001Dear Dr. Chernew:&nbsp;On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations; our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the opportunity to share our comments regarding Medicare beneficiary cost-sharing in rural facilities.In particular, we thank the Medicare Payment Advisory Commission (MedPAC) for recognizing that critical access hospitals (CAHs) are vital care access points for their communities and, as such, their financial stability and sustainability are critical. We support the Commission’s recommended changes to beneficiary cost sharing in CAHs, including to ensure that total payments to CAHs remain unchanged. However, rural health clinics (RHCs) also serve as important access points; as such,&nbsp;we encourage the commission to&nbsp;examine&nbsp;more closely the potential impact of its proposed changes to their beneficiary cost-sharing structure.<h2>COST SHARING FOR OUTPATIENT SERVICES AT CAHS</h2>During the January 2025 meeting, commissioners discussed patient cost sharing for outpatient services in CAHs and its impact on care access. The commission voted to recommend that CAH outpatient beneficiary cost-sharing be set at 20% of the payment amount and subject to a cap equal to the inpatient deductible. The AHA appreciates MedPAC’s consideration of outpatient patient cost sharing in CAHs and agrees it poses challenges to Medicare beneficiaries.Currently, CAHs receive cost-based fee-for-service (FFS) Medicare payments. As the commission concluded, these payments provide them with much-needed financial support. However, under this system, Medicare calculates beneficiaries’ cost-sharing for outpatient services as a percentage of charges, as compared to the outpatient prospective payment system (PPS) where beneficiary cost-sharing is a percentage of the outpatient PPS payment rate. As a result, half of CAH FFS Medicare outpatient payments are from beneficiary coinsurance.1,2 The majority of rural Medicare beneficiaries do not directly pay this coinsurance because many have supplemental coverage in Medigap or Medicaid. However, for the small proportion that do not have this coverage, these costs may be an undue financial burden and a barrier to accessing care. We share in the concerns presented by the commission regarding the implications of this cost-sharing structure for patient access to care and financial burden, especially in these historically underserved communities.Commission staff presented a policy solution to reduce beneficiary cost-sharing for outpatient services in CAHs. Under this solution, cost-sharing would be reduced from 20% of charges to 20% of the outpatient PPS payment rate. Additionally, a cap would be placed on the CAH outpatient coinsurance amount equal to the inpatient deductible; for 2025, this amount is $1,676. Importantly, the policy solution also would ensure that total payments to CAHs remain unchanged. That is, any reductions in CAH payments resulting from reductions in beneficiary cost-sharing would be made up by the Medicare program. We agree with this framework and emphasize the importance of maintaining stable and consistent total payments for CAHs. Indeed, any reductions in CAH payments would be extremely detrimental to their financial sustainability and, in turn, to beneficiary access to care. The commission itself recognized that “many CAHs would struggle financially if they did not receive [cost-based] FFS payment rates.” In fact, 70 CAHs have already closed or had to significantly scale back their services since 2005, including the closure of inpatient units.3Staff indicated that its recommendation, however, would mean an additional $1.3 billion would flow to MA plans in capitation payments. The fact that this would happen at a time when MedPAC itself has found that MA plans were overpaid by $88 billion is of great concern to the AHA.4 As such, we continue to urge the commission to fully study the role MA plays in rural communities and the impact plan policies and practices have on patients’ access to care and the financial solvency of rural providers.&nbsp;In particular, both the AHA and MedPAC have detailed numerous problems with MA prior authorization denials and other utilization review practices and their effects on timely access to care for patients.5 These dynamics are increasingly problematic as MA penetration grows in rural areas. Specifically, some plans are restricting patient access to Medicare-covered services, delaying patient care, and adding tremendous administrative burden to small hospitals without the resources to absorb these costs.6 Paying plans more in the face of such practices is misguided.<h2>COST SHARING FOR RURAL HEALTH CLINICS</h2>Commissioners also discussed challenges to RHC patient cost sharing and its impact on patient access to care. The AHA appreciates MedPAC’s consideration of this important topic and agrees that wide variation in RHC cost-sharing poses challenges to Medicare beneficiaries. However, we urge the commission to consider the impact payment cuts to RHCs would have on their financial sustainability, especially given payment cuts implemented in recent years.RHCs must be located in nonurbanized areas and predominantly serve underserved and rural populations. They provide outpatient services and are intended to increase access to primary care. Currently, Medicare pays RHCs 80% of an all-inclusive rate (AIR) per visit.7 Medicare beneficiary cost sharing at RHCs is set at 20% of RHC charges. Therefore, RHC payments are 80% of the AIR (from Medicare) and 20% of charges (from patient cost-sharing).8 As such, there is wide variation in beneficiary liability. For example, in independent RHCs, the average beneficiary cost sharing as a share of the AIR is 34%, whereas in provider-based RHCs, the average beneficiary cost sharing as a share of the AIR ranges from 17% to 38%.Staff presented a potential policy solution to address this variation — to reduce cost sharing by capping it at 20% of an RHC’s AIR. MedPAC found that for 2022, this would have reduced beneficiary cost sharing by 43% in independent RHCs and 8% to 49% in provider-based RHCs. However, unlike for CAHs, staff did not propose to ensure that total payment to RHCs remains unchanged. As such,&nbsp;AHA’s analysis indicates that the proposed policy would have translated to a $111 million payment cut to RHCs in 2024.These cuts come at a time when RHCs are still working to reconcile existing Medicare payment reductions. Specifically, the Consolidated Appropriations Act of 2021 set new payment limits capping reimbursement and only allowing growth by medical inflation. These cuts are particularly troubling because these facilities predominantly serve historically underserved communities and provide increased access to primary care, mental health care, pharmacy and dental services for these communities. RCHs act as safety net clinics designed to increase access to care for rural residents.9 Research has shown that over half of RHCs have night or weekend hours and the majority accept walk-in services and provide language interpretation services. Therefore, we urge MedPAC to carefully consider the impact these payment cuts would have on patient access to care. In particular, we urge the commission to&nbsp;ensure that total payments to RHCs remain unchanged. That is, any reductions in RHC payments resulting from reductions in beneficiary cost-sharing would be made up by the Medicare program.We thank you for your consideration of our comments. Please contact me if you have questions or feel free to have a member of your team contact Shannon Wu, AHA’s director of policy, at <a href="mailto:swu@aha.org">swu@aha.org</a> or 202-626-2963.Sincerely, /s/ Ashley B. Thompson Senior Vice President Public Policy Analysis and Development&nbsp;Cc: Paul Masi, M.P.P. MedPAC Commissioners<div>__________<div id="ftn1">1 RTI International. (2016). Medicare Copayments for Critical Access Hospital Outpatient Services – Update.&nbsp; <a class="ck-anchor" href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/contractor-reports/medicare-copayments-for-critical-access-hospital-outpatient-services-update.pdf" id="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/contractor-reports/medicare-copayments-for-critical-access-hospital-outpatient-services-update.pdf">https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/contractor-reports/medicare-copayments-for-critical-access-hospital-outpatient-services-update.pdf</a> 2 HHS Office of the Inspector General. (2014). Medicare Beneficiaries Paid Nearly Half of the Costs For Outpatient Services at Critical Access Hospitals.&nbsp;<a class="ck-anchor" href="https://oig.hhs.gov/reports/all/2014/medicare-beneficiaries-paid-nearly-half-of-the-costs-for-outpatient-services-at-critical-access-hospitals/" id="https://oig.hhs.gov/reports/all/2014/medicare-beneficiaries-paid-nearly-half-of-the-costs-for-outpatient-services-at-critical-access-hospitals/">https://oig.hhs.gov/reports/all/2014/medicare-beneficiaries-paid-nearly-half-of-the-costs-for-outpatient-services-at-critical-access-hospitals/</a> 3&nbsp;<a class="ck-anchor" href="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/" id="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/">https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/</a> 4&nbsp;<a class="ck-anchor" href="https://www.medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-status-report-Jan-2024.pdf" id="https://www.medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-status-report-Jan-2024.pdf">https://www.medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-status-report-Jan-2024.pdf</a> 5&nbsp;<a class="ck-anchor" href="/lettercomment/2023-11-30-aha-urges-medpac-examine-medicare-advantage-denials-hospital-market-basket" id="/lettercomment/2023-11-30-aha-urges-medpac-examine-medicare-advantage-denials-hospital-market-basket">/lettercomment/2023-11-30-aha-urges-medpac-examine-medicare-advantage-denials-hospital-market-basket</a> 6<a href="/guidesreports/growing-impact-medicare-advantage-rural-hospitals-across-america">/guidesreports/growing-impact-medicare-advantage-rural-hospitals-across-america</a> 7 As of 2021, they have been subject to a national statutory payment limit per visit (i.e., in 2025, this payment limit is $152). 8&nbsp;In contrast, beneficiary cost-sharing for clinician services in other settings such as federally qualified health centers (FQHCs) is set at 20% of the lesser of the physician fee schedule or FQHC charges. 9 University of Minnesota, Rural Health Research Center. (Dec. 2019). Access and Capacity to Care for Medicare Beneficiaries in Rural Health Clinics.&nbsp;<a href="https://rhrc.umn.edu/wp-content/uploads/2019/12/UMN-access-to-care-RHCS-policy-brief-12.10.19.pdf">https://rhrc.umn.edu/wp-content/uploads/2019/12/UMN-access-to-care-RHCS-policy-brief-12.10.19.pdf</a>&nbsp;</div></div> Fri, 28 Feb 2025 10:02:03 -0600 HCAHPS CMS Proposes Conditions of Participation for Rural Emergency Hospitals, Updates for Critical Access Hospitals The Centers for Medicare &amp; Medicaid Services (CMS) yesterday <a href="https://public-inspection.federalregister.gov/2022-14153.pdf">released</a> a proposed rule seeking comment on potential Conditions of Participation (CoPs) for certain rural and Critical Access Hospitals (CAHs) seeking to convert from their current status to be designated as a Rural Emergency Hospital (REH). In addition, the agency’s proposal would update certain CAH CoPs, which include changes to primary road and distance requirements, establishing a patient’s rights CoP and allowing for unified and integrated systems for certain requirements if the CAH is a part of a health system. The deadline to submit comments on these proposals is Aug. 29, 2022. <h2>AHA TAKE</h2> Ensuring that communities across the country have access to high quality, critical health care services is a top priority for the AHA and particular attention must be paid to the nation’s rural communities given the unique challenges rural providers face. The AHA supports CMS’ efforts to provide another avenue for rural providers to continue to serve their communities through the newly established REH designation, and we look forward to continuing to work with CMS on implementation of this program. The REH designation would enable providers to continue to provide essential services in their communities at a time when meeting rural health care needs is especially challenging. Rural hospitals often struggle with their remote location, limited workforce and constrained resources. Indeed, a record number of rural hospital closures occurred in 2020. In addition, while we continue to review the proposed updates to CAH CoPs in more detail, we are encouraged by and supportive of the agency’s interest in and recognition of the benefit of allowing a system-level approach for compliance with certain requirements. <h2>HIGHLIGHTS FROM THE PROPOSED RULE</h2> <h3>Rural Emergency Hospitals</h3> REHs were established as a new provider type by the Consolidated Appropriations Act of 2021 in an effort to address concerns that certain rural hospitals would not be able to sustain operations and communities would suffer from a loss of critical health care services. Under the new REH designation, CAHs and certain rural hospitals have the opportunity to convert to a REH, allowing those entities to continue to provide certain essential health care services to the communities they serve without providing the full suite of inpatient acute care services. If a CAH or rural hospital coverts to a REH, they are permitted to provide emergency services, observation care and certain additional medical and health outpatient services if the provider chooses. However, the annual per patient average stay may not exceed 24 hours. Given the unique nature of REHs, CMS, in its proposed rule, lays out several REH-specific CoPs that seek to align with certain CAH and ambulatory surgical center CoPs already in existence. These include aligning governing body and organizational structure requirements with those that currently apply to CAHs; aligning the provision of services CoP with current CAH requirements; requiring REHs to comply with both the CAH and hospital emergency services CoPs; aligning laboratory and radiological services requirements with current CAH CoPs; and creating a new pharmaceutical services CoP that aligns with current requirements for CAHs, among others. While many of the proposed compliance standards for REHs align with standards already in place for CAHs, CMS is seeking comment on several proposed REH-specific provisions, which include: <ul> <li>The ability of a REH to provide low-risk childbirth-related labor and delivery services;</li> <li>Whether the agency should require that a REH choosing to provide labor services also provide outpatient surgical services in the event that surgical labor and delivery intervention is necessary; and</li> <li>Whether it is appropriate for a REH to allow a doctor of medicine or osteopathy, physician assistant, nurse practitioner or clinical nurse specialist, with training or experience in emergency medicine, to be on-call and immediately available by telephone or radio contact and available on site within a specified timeframe.</li> </ul> Finally, the REH provisions in this proposed rule focus solely on CoPs. Provisions pertaining to payment, quality measurement, program designation and enrollment will be included in separate rulemaking, which we expect to be the agency’s Calendar Year 2023 Outpatient Prospective Payment System proposed rule, which has not yet been released. <h3>Proposed Updates to CAH CoPs</h3> In its proposed rule, CMS seeks comment on updates to certain CoPs for CAHs, including: Location and distance requirements. CMS proposes adding a definition for “primary roads” to its location and distance requirements and clarifying that the location distance for a CAH is more than a 35-mile drive on primary roads from a hospital or another CAH. Under the proposal, “primary road” would be specified as “a numbered Federal highway; or a numbered state highway with two or more lanes each way.” If finalized, CMS intends to establish a centralized, data-driven review process of all hospitals and CAHs within a 50-mile radius of the CAH with a follow-up investigation on expanded health care capacity and access within a 35-mile radius of the CAH. CAHs with no new hospitals in a 50-mile radius will be automatically recertified, while those with new hospitals within the 50-mile radius will be subject to additional review. Patient’s Rights. CMS proposes to establish a CoP for patient’s rights that would set forth the rights of all patients to receive care in a safe setting and provide protection for a patient’s emotional health and safety and physical safety. This CoP would include requirements for the CAH to inform patients of their rights; address privacy and safety; adhere to the confidentiality of patient records; ensure appropriate use of restraint and seclusion; and adhere to patient visitation rights. Allowing for Unified and Integrated Systems for Certain Requirements. The agency proposes to allow CAHs that are part of a system containing more than one hospital or CAH to utilize a system-level approach to comply with CoPs for infection control and prevention and antibiotic stewardship programs; medical staff; and quality assessment and performance programs. These updates would align CAH opportunities for a system-level approach with hospital standards currently in place. In these instances, the single governing body for a system would be responsible for ensuring each separately certified CAH is in compliance with the applicable standards. <h2>NEXT STEPS</h2> <ul> <li>Please share this Special Bulletin with your leadership team, chief compliance officer and other senior management.</li> <li>Inform AHA staff of any significant concerns associated with the proposed rule.</li> <li>The deadline for comments on the proposed rule is Aug. 29, 2022.</li> </ul> <h2>FURTHER QUESTIONS</h2> If you have further questions, please contact Nancy Foster at <a href="http://mailto:nfoster@aha.org" target="_blank">nfoster@aha.org</a> or Mark Howell at <a href="http://mailto:mhowell@aha.org" target="_blank">mhowell@aha.org</a>. Fri, 01 Jul 2022 11:24:20 -0500 HCAHPS Members in Action Maternal Case Study: Partnering to Improve Birth Outcomes in a Rural Community /case-studies/2021-03-03-members-action-maternal-case-study-partnering-improve-birth-outcomes-rural In 2015, Kearny launched the Pioneer Baby program in partnership with KU School of Medicine-Wichita to improve pregnancy and birth outcomes by reducing pregnancy complications, premature births, low- or extremely high-birth weight, and cesarean sections while increasing breastfeeding rates. The hospital also tapped outside funding, such as grants and local large employers, to upgrade computer software and purchase a 4D ultrasound machine. <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/partnering-to-improve-birth-outcomes" target="_blank" title="Partnering to Improve Birth Outcomes">Partnering to Improve Birth Outcomes</a></div> &nbsp; Wed, 03 Mar 2021 12:30:29 -0600 HCAHPS CMS extends deadlines for submitting HCAHPS, interoperability data /news/headline/2021-02-09-cms-extends-deadlines-submitting-hcahps-interoperability-data The Centers for Medicare &amp; Medicaid Services yesterday extended from Feb. 8 to March 17 the deadline for inpatient prospective payment system hospitals and PPS-exempt cancer hospitals to submit third quarter 2020 Hospital Consumer Assessment of Healthcare Providers and Systems data. In addition, CMS extended from March 1 to April 1 the deadline for eligible hospitals to submit calendar year 2020 electronic clinical quality measures to the Hospital Inpatient Quality Reporting Program and Medicare Promoting Interoperability Program. The agency also is extending the deadline to attest to the other four objectives of the Promoting Interoperability Program — Health Information Exchange, Provider to Patient Exchange, Public Health and Clinical Data Exchange — from March 1 to April 1. CMS said it will continue to monitor the situation for potential adjustments and update submission deadlines accordingly. Hospitals unable to submit the data due to an <a data-fontcolor="1" href="https://nam11.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3Do5Ps-NGTETCBkKNSISF-fw~~%26pe%3Di3BX1BNjYytF_CTCKzkS6BJW2YPkeO_lCXIaULJGmR8w_hB7NggukBBifWMcoskDwnraaGHspDVEBuJL95M8EA~~%26t%3DHPNQpByvHmDZ0iKxelERNg~~&amp;data=04%7C01%7Ctjordan%40aha.org%7C7be3e43e78af4a25983a08d8cd3ff3af%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637485021852541383%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&amp;sdata=VRSQmvg%2BLhu0bPtOQSNOlLpIG2bNW2xHzVVPE2xgm3o%3D&amp;reserved=0" originalsrc="http://send.aha.org/link.cfm?r=o5Ps-NGTETCBkKNSISF-fw~~&amp;pe=i3BX1BNjYytF_CTCKzkS6BJW2YPkeO_lCXIaULJGmR8w_hB7NggukBBifWMcoskDwnraaGHspDVEBuJL95M8EA~~&amp;t=HPNQpByvHmDZ0iKxelERNg~~" shash="KnbNMWfAPB1DNepSFYzKTmTS0AdH3Jr11Hn1YennW/e84ZyBolbSrtvJ+w2qStwVvkUt6r0MKO5UU76Q718I92jGTr8XuIsYVOGrxXKovJipochWgUSpd7F+iRz0HkFctFVF9kYfmFo88azxf6oUFSMGApC7hzi2m3tM6o7MYSk=" target="_blank">extraordinary circumstance</a> or <a data-fontcolor="1" href="https://nam11.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3Do5Ps-NGTETCBkKNSISF-fw~~%26pe%3DVGC-eMf8HrSO0iQwMJJmngKY-RpkcnWTNwfcfdvqA8EshgDBAKVkQDEABnl5M9sGsCkOSVM5kUu-GL7R4OXNtQ~~%26t%3DHPNQpByvHmDZ0iKxelERNg~~&amp;data=04%7C01%7Ctjordan%40aha.org%7C7be3e43e78af4a25983a08d8cd3ff3af%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637485021852551374%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&amp;sdata=RIaOWORYScm6cf31fecFadJYzewkpVq0tAVZNZVoys4%3D&amp;reserved=0" originalsrc="http://send.aha.org/link.cfm?r=o5Ps-NGTETCBkKNSISF-fw~~&amp;pe=VGC-eMf8HrSO0iQwMJJmngKY-RpkcnWTNwfcfdvqA8EshgDBAKVkQDEABnl5M9sGsCkOSVM5kUu-GL7R4OXNtQ~~&amp;t=HPNQpByvHmDZ0iKxelERNg~~" shash="ReHai24hHjHe+Mo67oj3q/o2AdTdYSdx6ecxIZv4jqhpy8YZqxJaXP0hxE46X5Bibc9ZjKVC4hc9HSg5Edk+ZXlpShu4L+pPvTqGPp5W/cHfuewctgDp0M26tfYH/PcyusmYOc2lImivl6wVXwlbGAZfuIYwOMIgFf514wojaUU=" target="_blank">hardship</a> may request an exception to the requirement. AHA had <a data-fontcolor="1" href="https://nam11.safelinks.protection.outlook.com/?url=http:%2F%2Fsend.aha.org%2Flink.cfm%3Fr%3Do5Ps-NGTETCBkKNSISF-fw~~%26pe%3DWUNVmcI89aYgeGEbzOZgkQ7GAOwK2tfGZFu-DaQW7vxh-grx23U7OKr6VD7XtNetnNtT54XmwPD3IOnEb-o-Mg~~%26t%3DHPNQpByvHmDZ0iKxelERNg~~&amp;data=04%7C01%7Ctjordan%40aha.org%7C7be3e43e78af4a25983a08d8cd3ff3af%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637485021852551374%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&amp;sdata=C3MOBCPkrFahbDlodku%2Fq%2FIIJqTHUFpmOiGxzkx5dEo%3D&amp;reserved=0" originalsrc="http://send.aha.org/link.cfm?r=o5Ps-NGTETCBkKNSISF-fw~~&amp;pe=WUNVmcI89aYgeGEbzOZgkQ7GAOwK2tfGZFu-DaQW7vxh-grx23U7OKr6VD7XtNetnNtT54XmwPD3IOnEb-o-Mg~~&amp;t=HPNQpByvHmDZ0iKxelERNg~~" shash="uOuiuLSxKs17lWCmksLNIbAihbMZ4iSsiukatVIWLE3nyCDgtU6YM1sTFVewGqKEKQyUHqAUiKtBoj0H3hcgYv02lgxnblhAwiBm6cvZGrrmurMhLr8ja5e606n/JLYe2XkHAcDj07fS5IDYOw1axLgShML0p535AMDZpk1VYmY=" target="_blank">urged</a> CMS to extend the deadline for hospitals to submit 2020 data for the Medicare Promoting Interoperability Program, citing problems this year with the system used to submit the data. Tue, 09 Feb 2021 14:01:14 -0600 HCAHPS Getting the Most from HCAHPS Surveys /advancing-health-podcast/2019-09-11-getting-most-hcahps-surveys On this AHA Advancing Health podcast, Nancy Foster, AHA vice president of quality and safety policy, moderates a discussion on the need for an update to the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Also joining the conversation are AHA’s Akin Demehin, director of policy, and Caitlin Gillooley, senior associate director for behavior health and quality policy. <hr /> Wed, 11 Sep 2019 10:31:28 -0500 HCAHPS Hospital associations: HCAHPS survey needs updates /news/headline/2019-07-25-hospital-associations-hcahps-survey-needs-updates The patient experience survey required by the Centers for Medicare &amp; Medicaid Services for all U.S. hospitals needs modernizing, according to a <a href="https://www.fah.org/issues-advocacy/quality-and-patient-safety/modernizing-the-hcahps-survey">paper</a>&nbsp;released today&nbsp;by the AHA and other national hospital associations, citing falling response rates after 10 years in the field and incomplete topic coverage. “It is time to re-think the Hospital Consumer Assessment of Healthcare Providers and Systems to ensure it is capturing information on critical aspects of care as it is delivered today and that patients can choose to provide their responses in the way that is most convenient for them,” said Robyn Begley, AHA chief nursing officer and CEO for its American Organization for Nursing Leadership, at a briefing today on the report. Co-authored by the AHA, Federation of ��s, America's Essential Hospitals, the Association of American Medical Colleges and the Catholic Health Association of the United States, the report’s recommendations include shortening the survey, adding language options and creating a digital avenue for patients to respond, instead of the current methods via phone and mail. Thu, 25 Jul 2019 14:24:46 -0500 HCAHPS New Report Shows Benefit of Modernizing HCAHPS Patient Experience Survey /press-releases/2019-07-25-new-report-shows-benefit-modernizing-hcahps-patient-experience-survey <img alt="HCAHPS logo" data-entity-type="file" data-entity-uuid="ff9f4bbc-2c99-439c-ab33-146f9b0a533c" src="/sites/default/files/inline-images/HCAHPS%20logo.PNG" width="730" height="139" class="align-center"> Today, five major hospital associations released <a href="/system/files/media/file/2019/07/FAH-White-Paper-Report-v18-FINAL.pdf">Modernizing the HCAHPS Survey: Recommendations from Patient Experience Leaders</a>, a paper that explores how to update patient experience surveying to best improve patient care. The HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems) is a 32-question patient satisfaction survey required by CMS for all U.S. hospitals. Researchers found that response rates to the HCAHPS survey are falling and that after ten years in the field, the survey needs a refresh. Recommendations include the creation of a digital avenue for patients to respond to the survey (right now phone and mail are the only options), as well as shortening the survey. A full list of key findings and recommendations can be found below. The paper was co-authored by the Federation of ��s (FAH), �� Association (AHA), America's Essential Hospitals, the Association of American Medical Colleges (AAMC) and the Catholic Health Association of the United States (CHA). “Great hospital care needs to be patient centered. Providing the best care, meeting patient expectations and keeping them comfortable and well informed is key,” said FAH President and CEO Chip Kahn. “Updating and improving the HCAHPS survey could have a major impact on improving care.” “Being a nurse on the frontlines of providing care showed me why including the patient experience is crucial in order to have a complete quality picture,” said Robyn Begley, chief nursing officer of the �� Association and chief executive officer of the American Organization for Nursing Leadership. “America’s hospitals and health systems believe strongly that HCAHPS is a critical patient experience survey that has important benefits for both patients and the providers that care for them. But, as our report clearly lays out, it is time to re-think HCAHPS to ensure it is capturing information on critical aspects of care as it is delivered today and that patients can choose to provide their responses in the way that is most convenient for them.” “Our hospitals work hard to overcome the social and economic challenges their vulnerable patients face and that affect the care experience – language barriers and low health literacy, for example,” said Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals. “This research shows more work is needed to ensure all hospitals ask the right questions in a culturally competent, easily understood way and without burdening patients or providers.” “This important work demonstrates the commitment of hospitals in improving the experiences of care for patients. Our recommended approaches to modernizing the HCAHPS survey to reflect changes in health care delivery and advancements in technology will help ensure patients are empowered to provide valuable feedback,” said Janis Orlowski, MD, chief health care officer of the Association of American Medical Colleges. “The patient is at the center of all we do as Catholic healthcare. An updated HCAHPS survey will give us a better understanding of how patients experience the care they receive in our hospitals and how we can improve our care delivery,” said Sr. Mary Haddad, CHA President and CEO. The associations interviewed hospital and health system patient experience leaders (PELs), the people who operate and manage the patient experience activities within their organizations. This allowed the authors to gather real world insights into the effectiveness of the HCAHPS. The paper examines in detail the current survey and the way it can be updated to better reflect the many changes and advancements that have happened in health care over the last 10 years. KEY FINDINGS <ul> <li>Response Rates Are Falling. PELs found that their HCAHPS survey response rates were falling each year. We examined national data and identified a drop in the national rate of patient responses from 33% in 2008 to 26% in 2017. Low response rates erode the validity of the survey. </li> <li>There Is Consensus the HCAHPS Survey Needs Updating. While most PELs thought the HCAHPS survey’s ability to provide patients with comparable data on patient experience was good, all felt the survey needs improvement. </li> <li>Topics Covered Are Important but Incomplete. When asked to identify the questions most important to keep PELs identified eight of the 27 core questions including questions related to communication with doctors and nurses. PELs further identified five topics/questions they would like to see added to the survey, such as questions related to efficiency and team-work of the care team.</li> <li>Research Is Needed on Additional Factors That Influence Patient Experience. More research needs to be done to identify social determinants of health that are outside of the hospital’s influence that impact the HCAHPS survey scores to ensure a level playing field when comparing hospitals. </li> <li>Literacy Levels Need to Be Re-evaluated. PELs generally felt that the health literacy level of the survey was too high and that responses of patients with lower health literacy levels were not being captured adequately. PELs also indicated the absence of appropriate literacy levels in non-English language HCAHPS survey versions. These segments of the population risk being under-surveyed and are not properly represented in the reported HCAHPS survey results.</li> </ul> &nbsp; TOP RECOMMENDATIONS <ul> <li>Add a digital mode of delivery to existing modalities; </li> <li>Shorten survey; </li> <li>Revise the survey in light of today’s shift to value-based care, changes in health care delivery, improvements in technology, and evolving patient priorities;</li> <li>Reframe the care transitions and discharge planning sections of the HCAHPS survey; and</li> <li>Periodically re-evaluate the HCAHPS survey.</li> </ul> &nbsp; The full report can be found by clicking <a href="/guidesreports/2019-07-24-modernizing-hcahps-survey">here</a>. &nbsp; ### &nbsp; Contact:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Colin Milligan, (202) 638-5491 About the �� Association (AHA) The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the improvement of health in their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit&nbsp;<a href="http://www.aha.org/">www.aha.org</a>. Thu, 25 Jul 2019 08:54:25 -0500 HCAHPS Modernizing the HCAHPS Survey /guidesreports/2019-07-24-modernizing-hcahps-survey <h2>Executive Summary</h2> The patient’s health care experience is considered one indicator of quality of care. Patient experiences with care received at hospitals have been captured and publicly reported at a national level since 2008 via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey consists of 32 questions focused mainly on patients’ experiences with the care they received during admission. Public reporting of the HCAHPS survey enables consumers to make informed health care decisions, including the hospital they choose. The HCAHPS survey also uses patient experience as a measurement for value-based payments hospitals receive through federal programs. We interviewed hospital and health system patient experience leaders (PELs) to gather their insights into the effectiveness of the HCAHPS survey in capturing patient experience. This paper will examine whether the current HCAHPS survey needs updating following the many changes and advancements that have happened in health care over the last 10 years since it was first implemented. We found that PELs strongly support patient experience measurement and its use as an indicator of quality. However, there is wide consensus among PELs on the need to modernize the HCAHPS survey to reflect the changes in health care delivery and information technology and the shift in patient expectations. This paper delves into a variety of recommendations derived by PELs across different types of hospitals and health systems for modernizing the HCAHPS survey. <h3>Key Findings</h3> <ol> <li>Response Rates Are Falling. PELs found that their HCAHPS survey response rates were falling each year. We examined national data and identified a drop in the national rate of patient responses from 33% in 2008 to 26% in 2017. Low response rates erode the validity of the survey data.</li> <li>There Is Consensus the HCAHPS Survey Needs Updating. While most PELs thought the HCAHPS survey’s ability to provide patients with comparable data on patient experience was good, all felt the survey needs improvement.</li> <li>Topics Covered Are Important but Incomplete. PELs found that eight of the 27 core questions were important to keep. PELs further identified five topics/questions they would like to see added to the survey, such as questions related to efficiency and team-work of the care team.</li> <li>Research Is Needed on Additional Factors That Influence Patient Experience. More research needs to be done to identify social determinants of health that are outside of the hospital’s influence that impact the HCAHPS survey scores to ensure a level playing field when comparing hospitals.</li> <li>Literacy Levels Need to Be Re-evaluated. PELs generally felt that the health literacy level of the survey was too high and that responses of patients with lower health literacy levels were not being captured adequately. PELs also indicated the absence of appropriate literacy levels in non-English language HCAHPS survey versions. These segments of the population risk being under-surveyed and are not properly represented in the reported HCAHPS survey results.</li> </ol> <h3>Top Recommendations</h3> <ol> <li>Add a digital mode of delivery to existing modalities;</li> <li>Shorten survey;</li> <li>Revise the survey in light of today’s shift to value-based care, changes in health care delivery, improvements in technology, and evolving patient priorities;</li> <li>Reframe the care transitions and discharge planning sections of the HCAHPS survey; and</li> <li>Periodically re-evaluate the HCAHPS survey.</li> </ol> <a href="/system/files/media/file/2019/07/FAH-White-Paper-Report-v18-FINAL.pdf">Read the entire report by clicking on the link below.</a> Wed, 24 Jul 2019 16:35:21 -0500 HCAHPS