The standardized survey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been used by hospitals since 2006 as an indicator of quality of care. Developed jointly by the federal Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services (CMS), it is intended to enable comparisons among hospitals and incentivize quality improvement; hospitals must participate or face financial penalties.

But according to a recent report, Modernizing the HCAHPS Survey: Recommendations from Patient Experience Leaders, it may be time for a revision. Five hospital groups, including the Federation of American Hospitals (FAH) and the American Hospital Association, published the report in July. Among the issues the report identifies are falling response rates and the lag time between when the surveys are sent and when results are reported.

The HCAHPS survey includes 32 questions about hospitalized patients' experiences communicating with physicians and nurses, the cleanliness of the facility, and pain management, among other measures of care. Many of the questions relate specifically to nursing care.

Surveys are sent to patients between 48 hours and six weeks after discharge. It may take up to 21 months for results to be posted on Hospital Compare, part of the CMS's hospital quality initiative, where data from HCAHPS and other sources are publicly available online to provide hospital performance and quality information to consumers.

Patients' response rates have dropped from 33% in 2008 to 26% in 2017. Possible reasons include the length of the survey-which can be further increased if hospitals add questions specific to their facility-and the general proliferation of surveys burdening the public. Patients may also find the phrasing of questions difficult.

Report recommendations include shortening the survey while adding some neglected topics such as efficiency and teamwork, and reevaluating the literacy level. Patient experience leaders [PELs] surveyed thought that the current literacy level was too high, thus the responses of patients with lower literacy levels were not captured adequately. Revisions should also incorporate the shift to value-based care, changes in health care delivery, technology advances, and new patient priorities. Periodic reevaluation was also recommended.

Whether nurses had input into the report isn't clear. When asked if the PELs had nursing backgrounds, FAH spokesman Sean Brown told AJN he wasn't sure of their professional credentials before being designated as PELs by their health care organizations.

Read the full recommendations at http://www.aha.org/guidesreports/2019-07-24-modernizing-hcahps-survey.-Gail M. Pfeifer, MA, RN