Hospice providers said if the surveys could be done by family members electronically, it might boost response rates. Right now, the third-party vendors send surveys by mail, over the phone or both.
"If we could move up in technology and email the survey, or text it, I think we'd get a much higher return rate—I throw away a lot of mail," said Dr. Michael Roffers, chief medical officer for Interim's operations in Texas and New Mexico.
The CMS said it's currently evaluating alternative modes of CAHPS survey administration, including email.
The CMS also doesn't allow the vendors to put the logo of the hospice provider on the mailed package, so family members can easily throw away the survey by mistake.
The length of the survey, 47 questions, also could be a contributor to the low response rates, Bullard said.
She added that the questions can easily be confusing for family members if they don't read them carefully. The survey has similar questions phrased in different ways as a tactic to elicit consistent responses. Bullard wonders if sometimes people just misunderstand how questions are worded and answer incorrectly.
But hospice providers can't follow up with family members to further discuss their answers. The CMS requires vendors to de-identify the respondents when they send the results back to the hospice providers.
"There are a very specific set of rules by the CMS," said Tony Kudner, vice president of Seasons Hospice and Palliative Care, based in Rosemont, Ill. "You have to be very compliant and careful."
Despite the limitations, providers say the survey results can still help them improve care.
For instance, Seasons Hospice used the surveys to improve how it treats patients' pain after responses showed some family members weren't satisfied.
After reviewing its scores, Seasons in late 2016 implemented SNAP, which stands for shortness of breath, nausea, anxiety and pain. Each hospice team member is now trained to check for each of these things through conversations with the patient or family member during every visit.
Seasons also ramped up its use of quality improvement specialists shortly after the Hospice Quality Reporting Program went into place.
"We have a director and vice president of quality, and then we have folks at every one of our sites who are responsible for monitoring and interpreting the results so we can put some specific plans in place—continuing to do the good stuff or working on the stuff where folks are saying there is room for improvement," Kudner said.
The 2% reduction in Medicare payment is a "huge motivation" for hospices to report and review their surveys, Person at NHPCO said, especially because hospices only received a 1% bump in Medicare payments in 2018, down from the 2.1% increase they received in 2017.
At Interim, there's a growing focus on following up with the family members during treatment to ensure all their needs are being met. Bullard said the new information on Hospice Compare has been especially helpful.
"I do love it because you can see how you're doing next to your competitors," Bullard said. "We can say all day long we give great care, but if our numbers don't add up, it doesn't mean much."
