The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program is a multiyear survey initiative to support and promote the assessment of consumers’ experiences with health care.
The Centers for Medicare & Medicaid Services (CMS) define CAHPS® as surveys that ask patients (or in some cases their families) about their experiences with their health care providers and plans, including hospitals, home health care agencies, doctors, and health and drug plans, among others. The surveys focus on matters that patients themselves say are important to them and for which patients are the best and/or only source of information.
CMS then publicly reports the results of its patient experience surveys, and some surveys affect payments to CMS providers.
CAHPS® – When Did it Start?
The Agency for Healthcare Research and Quality first launched the CAHPS program in October 1995 in response to concerns about the lack of good information about the quality of health plans from the enrollees’ perspective. Over time, the program has expanded beyond its original focus on health plans to address a range of health care services and meet the various needs of health care consumers, purchasers, health plans, providers, and policymakers.
What Does CAHPS® Cover?
The CAHPS® surveys measure 10 key domains of patients’ experience of care to assess the following:
- Getting Timely Care, Appointments and Information (core)
- How Well Providers Communicate (core)
- Care Coordination (core)
- Courteous and Helpful Office Staff (core)
- Patient’s Rating of Provider (core)
- Access to Specialists
- Health Promotion and Education
- Shared Decision-Making.
- Health Status and Functional Status
- Stewardship of Patient Resources
Who Can Participate in CAHPS®?
A random sample of health plan members is selected from eligible Medicare Advantage (MA) contracts to participate in the CAHPS program each year. The surveys are administered between March and June, beginning with surveys distributed by mail and concluding with telephone-assisted surveys for participants who have not responded.
So Why Are CAHPS® Ratings Important?
The patient care experience is broadly recognized as a core element of health care quality.
Patients care about the experience of their care, and research has demonstrated that communication and other elements of the care experience are key aspects of the perceived quality of care. The patient care experience has also proved directly related to clinical outcomes, as they are more engaged and adherent to the recommended plan of care.
A positive patient experience is a huge benefit to the organization as a business, such as decreased malpractice risk and staff turnover. Patient experience is increasingly tied to financial incentives in value-based care. Public and private payers alike have begun to recognize patient experience as a core element of quality, and trends reflect a growing focus on patient experience as an element of compensation structures.
CAHPS® and Value-Based Care Payments
CAHPS® surveys are an integral part of CMS’ efforts to improve healthcare in the U.S. Scores also affect federal payments issued to healthcare entities by the Centres for Medicare and Medicaid Services (CMS). Some CAHPS® surveys are used in Value-Based Purchasing (Pay for Performance) initiatives. These initiatives represent a change in the way CMS pays for services. Instead of only paying for the number of services provided, CMS also pays for providing high quality services. The quality of services is measured clinically, administratively, and through the use of patient experience of care surveys.
If You Are a Healthcare Provider…
Seventy percent of the CAHPS® survey is comprised of questions regarding member’s perception of their interaction with health care professionals. That’s why it is important to deliver exceptional service during every patient interaction. The most important reason to improve your CAHPS scores is because it will be a reflection of your efforts to improve the quality of care for your patients, But you also stand to benefit in other ways from improving your scores by increasing reimbursement, avoiding penalties and gaining a competitive advantage.
Remember that CAHPS® survey does not measure customer satisfaction but instead measures how patients perceive aspects of their care, how you made them feel, and the quality of care that you provided. The survey asks questions about the patients’ experience from the time they walk into the door, throughout the entire visit, and postvisit interactions. This means you will be evaluated for the patients’ interactions with your entire team.
For more information about the CAHPS program and its surveys visit AHRQ.com.
If you’re looking for a value-based care partner to help you discover how you can improve patient experience and organizational performance, let’s talk. Call us at (571) 489-7777 for a free consultation today.