Indeed, data show that the overall response rate for the HCAHPS survey has been steadily declining. The response rate for patients discharged from October 2006 to June 2007 was 34% but dropped to 27% from July 2017 to June 2018, the most recent time period for which data is available.
According to the CMS notice, it will seek input on the feasibility of an electronic HCAHPS survey.
Press Ganey, the largest vendor of the HCAHPS survey, offers separate email and text questionnaires to its hospital customers. Hospitals using those electronic surveys experience three to four times more responses compared with HCAHPS, said Deirdre Mylod, the company’s senior vice president for research and analytics.
Electronic surveys may also be less costly to deploy than mail and phone surveys, Phillips said. It would require fewer resources like paper, but hospitals would need to make initial investments in technology.
The low response rates for HCAHPS likely mean hospitals are only getting a limited understanding of their patient experience. Providers are also missing information from patients with social risks like homelessness.
Intermountain has a response rate of about 20%. “Are we reaching all the demographics we serve? I think not,” Phillips said.
And because the surveys are conducted via phone and mail, the responses take longer to collect and analyze and are therefore less helpful for improvement work, said Deborah Larkin-Carney, vice president of quality at RWJBarnabas Health.
It takes four to eight weeks before the New Jersey-based system receives completed survey responses from its vendor Press Ganey.
“There is such a huge lag time …and your recollection of things can change,” Larkin-Carney said.
Phillips said she’s even received emails from patients who have complained about the length of the surveys and the questions, claiming some are redundant or confusing. “Most of the time they are frustrated with me, and say ‘Why are you sending me such a badly written survey?’ ” she said.
The way questions are phrased also makes the information less actionable, said Chao Wu, assistant vice president of patient experience at the Hospital for Special Surgery in New York City.
For instance, the mailed version of the survey asks patients how many times an action was done by selecting among “never,” “sometimes,” “usually” and “always.” One question is: “During this hospital stay, how often did doctors treat you with courtesy and respect?”
That doesn’t correlate to how clinical staff think about providing care, Wu argued, adding, “We talk about the quality of healthcare, not how many times we provide the service.”
Frustration with HCAHPS is high in large part because results are tied to reimbursement. It is part of the inpatient prospective payment system and the Hospital Value-Based Purchasing Program. Some commercial insurers use it to calculate payment rates.
The results are also publicly available to patients through Hospital Compare and factor into overall star ratings as well as in a separate rating for patient experience. But there are doubts about how much patients pay attention to it.
“I don’t think a lot of patients go to Hospital Compare,” Phillips said. “In fact, when patients look up a health system, they probably find Yelp more than they find Hospital Compare.”