Definitive Guide to HCAHPS Scores: A Key to Improving Patient Satisfaction in Hospitals

Key Takeaways on HCAHPS Scores

• HCAHPS provides a standardized measurement of patient hospital experiences, directly affecting financial reimbursement and hospital reputation

• Patient satisfaction scores account for 25% of Medicare reimbursement through the Value-Based Purchasing program

• 2025 updates introduced web-based options, new submeasures, and extend collection timeframes to 49 days

• Research shows connections between high HCAHPS scores, lower mortality rates, and favorable clinical outcomes

• Hospitals can improve scores through staff education, patient-centered approaches, and targeted quality initiatives

• Despite its importance, HCAHPS has limitations related to external factors and lack of department-specific feedback

What Are HCAHPS Scores?

The History and Development of HCAHPS

The healthcare landscape changed forever in 2002 when the Centers for Medicare & Medicaid Services teamed up with the Agency for Healthcare Research and Quality to develop HCAHPS.

Their goal was simple yet ambitious: create a standardized way to measure how patients experience hospital care.

Before this partnership, no standard method existed to collect patient satisfaction data.

Hospital reviews were largely subjective and often failed to reflect actual care quality.

This lack of standardization made it nearly impossible for patients to make informed decisions about their healthcare providers.

The National Quality Forum recognized the value of this initiative and endorsed HCAHPS in May 2005.

Later that year, in December, the federal Office of Management and Budget gave its final approval for nationwide implementation.

CMS officially rolled out the HCAHPS survey in October 2006, with the first public results appearing in March 2008.

The survey gained even more significance through the Patient Protection and Affordable Care Act of 2010, which included HCAHPS in the Hospital Value-Based Purchasing program.

This connection linked survey results directly to value-based incentive payments for discharges starting in October 2012.

Looking ahead, January 1, 2025, will mark the first major modernization of the HCAHPS survey since its 2008 launch, with significant updates set to take effect.

HCAHPS Survey Structure and Content

The current HCAHPS survey contains 29 questions designed to capture various aspects of the patient hospital experience.

This number will increase to 32 questions in 2025.

At its core, the survey features 19 essential questions about critical hospital experience elements.

These questions cover how well nurses and doctors communicate, how responsive staff members are, hospital cleanliness and quietness, medication communication, and discharge information.

These questions fall into specific categories: communication with physicians and nurses, hospital staff responsiveness, pain management, medication communication, discharge information, and overall hospital rating.

To ensure comprehensive data collection, the survey includes demographic questions about gender, race/ethnicity, insurance status, age, and education level.

It also contains three screening questions that guide patients to relevant sections of the survey.

Understanding the diverse patient population it serves, the HCAHPS survey comes in multiple languages.

You can find official versions in English, Spanish, Chinese, Russian, Vietnamese, Portuguese, and German.

How HCAHPS Scores Are Calculated

Survey Distribution and Collection Methods

HCAHPS surveys go to a random sample of adult inpatients across various medical conditions.

The survey reaches patients between 48 hours and six weeks after discharge – a timeframe that will extend to 49 days in 2025.

The survey isn't limited to Medicare beneficiaries.

Any adult who spends at least one night in a hospital qualifies, except those admitted with a psychiatric diagnosis.

Hospitals have options for administering the survey.

They can work with an approved survey vendor or collect their own HCAHPS data if they receive CMS approval.

The survey can be delivered through mail, telephone, mail with telephone follow-up, or active interactive voice recognition.

In 2025, web-based options will join these methods.

To ensure data accurately represents patient experiences throughout the year, hospitals must survey patients every month.

Hospitals under the Inpatient Prospective Payment System must collect and submit HCAHPS data to receive their full annual payment update.

Other facilities, like Critical Access Hospitals, can participate voluntarily.

From Responses to Metrics: The Calculation Process

HCAHPS results come from four consecutive quarters of patient surveys.

As each new quarter's data comes in, the oldest quarter rolls off.

The scores undergo adjustments to ensure fair comparisons between hospitals.

These adjustments account for factors not directly related to hospital performance but which influence how patients respond – things like survey mode and patient characteristics beyond a hospital's control.

Quality oversight is a critical part of the process.

The HCAHPS Project Team inspects survey administration procedures, conducts statistical analyses, and makes site visits to verify proper protocol adherence.

The scoring system looks at both improvement scores and achievement scores for each dimension.

Improvement scores compare a hospital to its past performance, while achievement scores compare it to national benchmarks.

The higher of these two scores counts.

A consistency score rewards hospitals that exceed minimum performance levels across all HCAHPS dimensions.

This score considers both the hospital's lowest-scoring dimension and achievement thresholds.

The overall HCAHPS summary appears as a 5-star rating, with 1-star being the lowest and 5-star the highest.

2025 HCAHPS Updates: New Changes and Implementation

Starting January 1, 2025, HCAHPS will undergo its most significant modernization since launch.

Patients will have new online options to complete the survey through three web-first approaches: email followed by mail, email followed by phone, or email followed by mail then phone for non-respondents.

Two current survey administration options will disappear.

Active interactive voice response and hospitals administering HCAHPS for multiple sites survey modes haven't been used since 2016 and 2019 respectively, so they're being eliminated.

The survey content is changing too.

Three new submeasures will address care coordination, restfulness of hospital environment, and information about symptoms.

This addition increases the total questions from 29 to 32.

At the same time, four questions about call-button use and care transitions will be removed.

These questions either reflect outdated hospital processes or duplicate information gathered elsewhere in the survey.

Other changes include extending the data-collection period from 42 to 49 days and ending the prohibition on patients' loved ones filling out the survey on their behalf (though patients will still be encouraged to complete it themselves).

The number of supplemental items will be limited to 12, aligning with CMS's other patient experience surveys.

Hospitals will also need to collect information about what language patients speak, and Spanish-speaking patients must receive the official CMS Spanish translation.

The Significance of HCAHPS in Healthcare

Financial Implications for Healthcare Facilities

HCAHPS scores directly impact your hospital's bottom line through Value-Based Purchasing programs from Medicare and other insurers.

Patient satisfaction scores account for 25% of a hospital's overall performance measurement used by CMS to determine Medicare reimbursement.

Hospitals with higher HCAHPS scores receive higher reimbursement rates from government payers like Medicare and Medicaid, as well as from private insurers.

Those failing to publicly report required quality measures, including HCAHPS, may see reduced annual payment updates.

Since July 2007, hospitals subject to the Inpatient Prospective Payment System have needed to collect and submit HCAHPS data to receive their full annual payment update.

The financial benefits go beyond direct reimbursement.

Satisfied patients typically return for future care and recommend services to others, creating additional revenue opportunities.

Impact on Hospital Reputation and Patient Choice

HCAHPS scores appear publicly on the Care Compare website and HCAHPS On-Line.

This transparency allows consumers to compare hospitals based on patient experiences.

High scores serve as a badge of honor, demonstrating your hospital's commitment to patient-centered care and attracting new patients seeking quality experiences.

Conversely, low scores can damage reputation, lead to negative word-of-mouth, and decrease patient trust.

The public reporting creates a standardized method for comparing hospitals locally, regionally, and nationally on topics important to healthcare consumers.

Quality Improvement and Patient-Centered Care

HCAHPS survey results help you identify areas needing improvement, allowing for targeted quality initiatives.

The surveys provide direct feedback from patients, enhancing engagement and building trust.

The public reporting creates new incentives for hospitals to improve care quality.

Since implementation, HCAHPS has shifted the focus toward more patient-centered approaches to healthcare delivery.

HCAHPS enhances accountability by increasing transparency about the quality of hospital care provided in return for public investment.

To improve scores, hospitals need comprehensive staff education, adequate time for patient care, and thorough patient education programs.

HCAHPS and Patient Outcomes

Correlation Between Patient Experience and Clinical Quality

Research shows interesting connections between HCAHPS scores and clinical outcomes.

Large hospitals with high surgical volumes tend to have high overall patient satisfaction scores.

Hospitals with lower mortality rates typically show higher patient satisfaction compared to facilities with high mortality rates.

Evidence suggests HCAHPS scores connect to favorable patient outcomes, though researchers need to conduct more studies to determine the exact nature of this relationship.

The Person and Community Engagement domain (which includes HCAHPS) makes up 25% of a hospital's performance evaluation by CMS, alongside safety, clinical care, efficiency, and cost reduction.

Criticisms and Limitations of HCAHPS as a Quality Measure

Despite its widespread use, HCAHPS has limitations.

Hospital characteristics and patient safety outcomes haven't consistently linked to patient satisfaction scores, suggesting other factors influence patient perceptions that HCAHPS doesn't capture.

Several external factors can affect HCAHPS scores beyond quality care: the health of the patient population, specialized care levels, patient-to-provider ratios, busy care settings, and staffing shortages all play roles.

Researchers need to determine exactly what additional factors beyond HCAHPS measures influence patient care perceptions.

Another limitation is that HCAHPS scores don't identify specific departments contributed most or least to patient perceptions, making targeted improvements challenging.

Improve Your HCAHPS Scores with Dialog Health's Two-Way Texting Solution

Dialog Health's two-way texting platform directly addresses HCAHPS challenges by enhancing patient communication throughout the care journey.

Our solution helps you deliver clear discharge instructions, send medication reminders, and gather real-time feedback before formal surveys are conducted.

The platform supports multiple languages to meet upcoming 2025 requirements while enabling personalized communication that drives improved scores in key measurement areas.

Our clients consistently report higher HCAHPS ratings in communication categories and can identify specific departments needing improvement—overcoming a significant HCAHPS limitation.

We only need 15 minutes of your time to demonstrate the immense value of our platform for your organization, and we're happy to do it at your convenience.

Brandon Daniell, Co-Founder	Written by Brandon Daniell                                                              Brandon has more than 15 years of business and program development experience in healthcare. Worked with some of the leading employers, physicians, payors, and hospital systems, including GTE (now Verizon), BCBS of TN, and Hospital Corporation of America.