How was the HCAHPS Survey developed?
The Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare
Research and Quality (AHRQ), another agency in the federal Department of Health and Human Services,
to develop HCAHPS. AHRQ carried out a rigorous, scientific process to develop and test the HCAHPS
instrument. This process entailed multiple steps, including a public call for measures; literature review;
cognitive interviews; consumer testing and focus groups; stakeholder input; a large-scale pilot test and a
number of small-scale field tests. In addition, CMS responded to hundreds of public comments generated
by several Federal Register notices.
In May 2005, the National Quality Forum (NQF)—which represents the consensus of many healthcare
providers, consumer groups, professional associations, purchasers, Federal agencies, and research and
quality organizations—endorsed the HCAHPS. In December 2005, the federal Office of Management and
Budget gave its final approval for the national implementation of HCAHPS. HCAHPS was also endorsed
by the Hospital Quality Alliance. CMS commissioned an independent research firm, Abt Associates Inc.,
to conduct an analysis of the benefits and costs of HCAHPS. The Abt report, which includes detailed cost
estimates for hospitals, can be found at:
http://www.cms.gov/HospitalQualityInits/downloads/HCAHPSCostsBenefits200512.pdf.
The HCAHPS Survey - Frequently Asked Questions Page 2
When did hospitals begin to implement the HCAHPS Survey?
Voluntary collection of HCAHPS data for public reporting began in 2006, and public reporting of
HCAHPS scores began in 2008. Since July 2007, hospitals subject to IPPS payment provisions
("subsection (d) hospitals") must collect, submit and publicly report HCAHPS data in order to receive
their full IPPS annual payment update (APU). IPPS hospitals that fail to report the required quality
measures, which include the HCAHPS survey, may receive an APU that is reduced by 2.0 percentage
points. Non-IPPS hospitals, such as Critical Access Hospitals, can voluntarily participate in HCAHPS.
HCAHPS Survey results also form the basis for the Patient Experience of Care domain in the Hospital
Value-Based Purchasing program.
Which modes of survey administration can be used for HCAHPS?
Because hospitals and survey vendors survey patients a number of ways, HCAHPS is available in four
different modes: Mail Only, Telephone Only, Mail with Telephone follow-up (also known as Mixed
mode), and Active Interactive Voice Response (IVR). Detailed information on the proper use of each
mode of survey administration can be found in the HCAHPS Quality Assurance Guidelines manual,
which is located at “Quality Assurance” at www.hcahpsonline.org.
CMS recognizes that patients’ responses to the survey may be affected by the mode of survey
administration. For instance, respondents typically give somewhat more positive responses when
surveyed by telephone, as compared to mail. Thus, choice of mode of survey administration could
potentially affect comparisons of hospitals. CMS conducted a large-scale experiment to test for mode
effects, and based on this research an adjustment has been built into the calculation of HCAHPS scores to
remove the effect of survey mode on how patients respond to HCAHPS survey items.