NewYork-Presbyterian CXO Rick Evans: New proposed changes to HCAHPS from CMS are encouraging

Recently, CMS announced a proposed set of changes to the HCAHPS survey program. The proposed changes are open for comment through early June of this year. They've been a long time coming. I believe they are not only welcome, but necessary.

As most leaders in healthcare know, the HCAHPS patient experience survey is required for adult inpatient hospitals and is part of the "Value-Based Purchasing" system. This means that results of the survey are publicly reported and impact hospital reimbursement. In more recent years, HCAHPS scores have also been converted to star ratings, which are increasingly resonating with consumers and patients. In other words, there are real stakes for improving HCAHPS results. In general, that is a good thing. The advent of HCAHPS and its public reporting and reimbursement structure about 15 years ago elevated patient experience for hospitals and health systems.

The challenge is that the HCAHPS survey — both its content and process - have not been updated significantly since its launch in 2008. The primary mode for survey administration has remained paper. The question sets have remained largely static. In recent years, survey response rates have dropped dramatically. This has led us to a point where, if HCAHPS is not updated, its credibility as a reliable source of data on patient needs and preferences is in jeopardy.

The new proposed regulations address a couple of critical issues. 

First, they offer additional modes for survey administration that incorporate electronic administration. This is a much-needed step forward. A range of administration modes are critical for us to continue to get the number of responses we need to have valid and actionable data at the inpatient unit level where the real work of patient experience improvement is done.

The proposed regulations also acknowledge a reality that has been present since patient surveying began: often, loved ones of patients fill out surveys when the patients cannot. The new regulations allow for this. We know that patients often come with a "constellation" of loved ones. Sometimes these individuals play a key role in the patient's care. At NewYork-Presbyterian, we seek to actively partner with family members and loved ones, to the benefit of all. This change recognizes this reality.

The proposed regulations also extend the official data collection period for the survey. Studies of HCAHPS data have shown that extending this timeframe can result in better response rates from a broader range of respondents, including Spanish-speaking and Black households. We all want to hear from more diverse respondents. We seek more patient voices, especially now when health equity is appropriately more in focus than ever before. This could help those efforts.

The proposed regulations also mention changes and adjustments to questions on the survey. Currently, the survey asks about physician and nursing communication, response to call bells, hospital environment, education about medications, the discharge process and also includes a somewhat duplicative and confusing group of questions on "care transitions." In our experience at NewYork-Presbyterian, patient understanding of these questions varies widely. This makes it difficult to develop and deploy meaningful interventions to address issues. Although the new proposed regulations do not specifically outline changes to the question set, they do reference the possibility of introducing new questions and domains in the future. I would encourage CMS to more broadly vet these possible changes with a special emphasis on connecting with diverse populations. Questions should focus on our patients' deepest priorities but also connect with factors that hospitals can address in our provision of care. 

These proposed changes could go into effect in the coming years, if fully adopted. As I said at the start of this, some changes, particularly expansion of survey modes, cannot come fast enough. I hope CMS will move as expeditiously as possible to get this done.  

I — and many of my colleagues across the country — still have even broader dreams for how we could better gather feedback on patient experience. With the advent of artificial intelligence, we should be able to do things like send customized surveys to patients, which focus on their unique experiences. We should be able to use the unstructured data in comments, letters, emails and other communication with health systems to glean insight and data. We should be able to find novel ways to reach parts of our communities whose voices are not always heard. We need the ability to get data more in real-time as well, rather than always looking backward to determine what we need to do better going forward. Quite simply, we need to listen more and better!

I hope more innovation comes to pass in the coming years. But I also welcome the possible improvements being outlined now by CMS. The journey to understand our patients and families, and to structure the care we provide to meet their needs, must continue to evolve if we are to foster trust in healthcare.  

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