Response to Comments

CMS Response to Public Comments Received for the HCAHPS Mode Experiment (CMS 2014 0153)

Comment: The Centers for Medicare and Medicaid Services (CMS) received a comment requesting testing a Likert response format in a grid pattern as part of the study for the supplemental questions.

Response: CMS appreciates your review and comments on the HCAHPS Mode Experiment.  The purpose of the planned HCAHPS mode experiment is twofold: (1) to re-examine the HCAHPS mode adjustments for the 32-item HCAHPS survey and re-calibrate, if necessary; and (2) to collect empirical evidence on the effect additional supplemental items on survey response rate and patterns of response to the HCAHPS items.

CMS conducts ongoing research on the surveys it develops and implements, including survey item and response formatting, in order to minimize cognitive burden and maximize survey validity, reliability and response rates.  Testing by the Agency for Healthcare Research and Quality (AHRQ) and the CAHPS Consortium supports the vertical response formatting employed in CAHPS surveys.¹

The HCAHPS Survey, like other CAHPS surveys, prohibits responses choices arranged in a matrix format and requires that the options be listed vertically. At present, there are no plans to modify the protocol for the response format, which is detailed in the Quality Assurance Guidelines.² Hospitals or survey vendors may add a reasonable number of hospital-specific supplemental questions to the HCAHPS Survey in conformity with the guidelines in the HCAHPS Quality Assurance Guidelines (pg. 74). Supplemental items need not follow a specific design format and are not submitted for review or approval by CMS.   However, the number of supplemental questions added to the HCAHPS Survey is reported to CMS.

1Harris-Kojetin, L. D., F. J. Fowler, J. A. Brown, J. A. Schnaier, and S. F. Sweeny. 1999. “The Use of Cognitive Testing to Develop and Evaluate CAHPS 1.0 Core Survey Items.” Medical Care 37 (suppl): MS10.

2Centers for Medicare and Medicaid Services (2014). CAHPS Hospital Survey (HCAHPS) Quality Assurance Guidelines, Version 9.0. Retrieved from http://www.hcahpsonline.org/Files/HCAHPS%20QAG%20V9%200%20MARCH%202014.pdf