Hospital groups: Patient satisfaction survey process needs a revamp

hospital doctor with patient
Hospital associations put out report on updating the Hospital Consumer Assessment of Healthcare Providers and Systems survey. (monkeybusinessimages/Getty Images)

The Federation of American Hospitals (FAH) along with four other major hospital associations say the required patient satisfaction survey for all U.S. hospitals is in need of some serious updates.

For starters, they said, the survey needs to go digital.

The "topics covered are important, but don't reflect where we are today," said FAH CEO Chip Kahn on a call with reporters. He was speaking as part of the released report (PDF) Thursday detailing specific potential changes.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a 32-question patient experience survey via mail and phone used by the government and hospitals around the country as a quality measurement. And in today’s evolving market, the Centers for Medicare & Medicaid Services (CMS) uses the survey to compare for value-based purchasing.

Ultimately, the HCAHPS is used as a tool to foster care improvement, provider accountability and quality transparency.

Kahn said patient response rates have fallen since the survey began a decade ago. Specifically, in 2008, the HCAHPS had a 33% response rate that dropped to 26% in 2017, and this drop was seen across all hospital sizes and demographics.

The report also found patient experience leaders (PELs)—the people who operate and manage the patient experience activities within their organizations—felt that the survey needed improvements and that the topics covered failed to address necessary topics related to efficiency and teamwork of the care team.

The report highlighted concerns that more research is needed to identify social determinants of health that are outside of the hospital’s influence to ensure a level playing field when comparing hospitals and that health literacy levels are being addressed adequately, especially in non-English language versions of the HCAHPS.

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The report on modernizing the HCAHPS survey included the following recommendations:

1. Add an electronic modality of delivery for the survey. This could be in the form of an email, an app, a website or possibly even a tablet upon hospital discharge.

2. The length of the survey needs to be shortened from its current 32 questions.

3. Some of the questions need to be reframed to address value-based care, healthcare technology and evolving patient priorities.

4. The survey should address the modernization of transitional care after discharge.

5. There should be a periodic reevaluation of the HCAHPS survey. Although Kahn noted that no specific length of time was recommended by the group to CMS for periodic survey updates, Claudia Salzberg, vice president of quality at FAH and a co-author of the study, suggested having between a three- to five-year review, similar to clinical study guidelines.
Robyn Begley, chief nursing officer of the American Hospital Association (AHA) and CEO of the American Organization for Nursing Leadership, stressed on the call that the healthcare system is very different than it was in 2008, including shorter hospital stays, more coordinated care across health systems and more care outside the traditional hospital setting.

“All quality measures need to reflect the updates in science and delivery of care,” she said.

RELATED: CMS plans to cut pain-management questions from HCAHPS survey

Begley noted that some of the biggest PEL complaints included surveys being conducted too long after hospital discharge and the lag time in hospitals getting survey results. Plus, patients resented being called during dinner time.

In addition, there was frustration by patients at the overlapping of surveys, as many people were receiving them in multiple settings such as a physician’s office, dialysis office, hospital, etc.

The report was co-authored by the FAH, AHA, America's Essential Hospitals, the Association of American Medical Colleges and the Catholic Health Association of the U.S. The results were simply recommendations for the CMS.