Response to comments

Response to Comments:

National Implementation of the Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) Survey
(CMS 10102, OMB 0938-0981)
November 6, 2023

Comment: One commenter requested that CMS share HCAHPS linear mean scores for the individual
composite measures because they provide more robust information on all patients and not just the
subset of patients who selected a particular response. The commenter also requested that linear mean
score percentiles be displayed in the summary table on www.hcahpsonline.org.
Response: The CMS Provider Data Catalogue provides linear mean scores for each HCAHPS individual
and composite measure. HCAHPS data sets at the national, state, and hospital level can be downloaded
by going to https://data.cms.gov/provider-data/search?fulltext=HCAHPS&theme=Hospitals, scrolling
down to the relevant HCAHPS dataset, and downloading the accompanying csv file. These files, the
“Patient Survey (HCAHPS) - National,” “Patient Survey (HCAHPS) - State,” and “Patient Survey (HCAHPS)
– Hospital,” display linear mean scores and HCAHPS Star Ratings for each HCAHPS measure for all
eligible hospitals participating in the HCAHPS program. (Note: In order for HCAHPS Star Ratings to be
calculated, hospitals must have at least 100 completed surveys in a four-quarter roll-up). Since 2013,
CMS has provided HCAHPS Star Ratings and linear mean scores in a downloadable database. Each
participating hospital also receives its own information in a public reporting Preview Report. The
current downloadable files were released on July 26, 2023. CMS will consider adding a separate HCAHPS
Percentiles Table of linear mean scores in the future. In the interim, distributions of the HCAHPS Star
Ratings and the HCAHPS Summary Star Ratings can be found on the official HCAHPS On-Line Web site at
https://hcahpsonline.org/en/hcahps-star-ratings/ under “HCAHPS Stars Ratings Distributions.”
Comment: One commenter expressed concern that the use of paper-only or telephone-only survey
administration of the HCAHPS survey will eliminate younger patients from answering the survey as they
are more likely to answer electronic versions. This same commenter requested that the HCAHPS survey
be limited to a maximum of 10 questions and that the phrasing of some questions be changed. Lastly,
the commenter requested a change in scoring method for the overall rating of the hospital question
from the top box method (response of 9 or 10) to an overall method (linear mean).
Response: CMS appreciates these comments and the important matters they raise. Through research,
analysis, and several large-scale mode experiments, CMS has learned that preference for particular
modes of survey administration varies with certain patient characteristics, and that younger and
maternity patients more often prefer telephone and web modes. In the FY 2024 IPPS Rule CMS finalized
several changes to the HCAHPS Survey beginning with January 2025 discharges, including the
introduction of three new web-based, sequential modes of survey administration: Web-Mail, WebPhone, and Web-Mail-Phone. Hospitals will have the option of implementing the HCAHPS Survey in one
of the continuing original modes (Mail Only, Phone Only, or Mail-Phone) or in one of the new web-first
modes: Web-Mail, Web-Phone, or Web-Mail-Phone. CMS adjusts HCAHPS scores for mode of survey
administration and for certain patient characteristics (such as age, service line, education, etc.) that
affect survey response but are beyond the hospital’s control. The current survey mode and patient-mix
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adjustments can be found on the official HCAHPS On-Line Web site at
https://hcahpsonline.org/en/mode--patient-mix-adj/.
The HCAHPS Survey is designed to elicit information that only the patient can provide about critical
aspects of patient care. Each item on the HCAHPS Survey has been carefully constructed, worded, and
tested, in both English and Spanish among patients and caregivers, to ensure that patients truly
comprehend and can appropriately respond.
The HCAHPS Survey balances the burden of survey length against the value of carefully constructed
survey items that measure critical areas of patient experience. The specific information produced by
HCAHPS both allows consumers to compare hospitals, and hospitals to target and improve the care they
provide.
Our testing has shown that “top-box” scoring is most useful to consumers in comparing and choosing
hospitals. Hospitals’ “top-box” scores are publicly reported on the Care Compare Web site; “middlebox” and “bottom-box” scores can be found in the Provider Data Catalog downloadable database. Since
2013 CMS has also provided the more granular linear mean scores of HCAHPS measures in both a
downloadable database and in hospitals’ Preview Reports. Linear mean scoring is explained in the
“HCAHPS Star Rating Technical Notes” document available on the official HCAHPS On-Line Web site
(https://hcahpsonline.org/en/hcahps-star-ratings/).

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