Consumer Assessment of Healthcare Providers & Systems (CAHPS)
The Centers for Medicare & Medicaid Services (CMS) develop, implement and administer several different patient experience surveys. These surveys ask patients (or in some cases their families) about their experiences with, and ratings of, 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 publicly reports the results of its patient experience surveys, and some surveys affect payments to CMS providers.
Experience is not the same as satisfaction
Patient experience surveys sometimes are mistaken for customer satisfaction surveys. Patient experience surveys focus on how patients experienced or perceived key aspects of their care, not how satisfied they were with their care. Patient experience surveys focus on asking patients whether or how often they experienced critical aspects of health care, including communication with their doctors, understanding their medication instructions, and the coordination of their healthcare needs. They do not focus on amenities.
Many of the CMS patient experience surveys are in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) family of surveys. Others are developed following CAHPS principles and used by CMS but are not CAHPS surveys. All surveys officially designated as CAHPS surveys have been approved by the CAHPS Consortium, which is overseen by the Agency for Healthcare Research and Quality (AHRQ).
CAHPS surveys follow scientific principles in survey design and development. The surveys are designed to reliably assess the experiences of a large sample of patients. They use standardized questions and data collection protocols to ensure that information can be compared across healthcare settings. CAHPS surveys are developed with broad stakeholder input, including a public solicitation of measures and a technical expert panel, and the opportunity for anyone to comment on the survey through multiple public comments period through the Federal Register. Finally, many CAHPS measures are statistically adjusted to correct for differences in the mix of patients across providers and the use of different survey modes.
CAHPS surveys are an integral part of CMS’ efforts to improve healthcare in the U.S. 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.
CMS Patient Experience Surveys include:
CMS CAHPS® Surveys
CAHPS® Survey for Accountable Care Organizations Participating in Medicare Initiatives
Other CMS Patient Surveys
Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey
CAHPS for ACOs
Overview: The CAHPS for ACOs survey was developed to collect information about patient experience of care received from Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (Shared Savings Program) and the Next Generation ACO Model. The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high quality care to their Medicare patients. The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.
About the survey: The CAHPS for ACOs survey is administered annually to samples of Medicare beneficiaries that receive care from providers that participate in ACOs. The survey uses a mixed mode data collection that includes two survey mailings and follow-up phone calls to beneficiaries that did not respond to the mailed questionnaire. The survey includes the core questions contained in the CAHPS Clinician & Group Survey (Version 3.0), plus additional questions to measure access to and use of specialist care, experience with care coordination, patient involvement in decision-making, experiences with a health care team, health promotion and patient education, patient functional status, and general health.
Public reporting and policy relevance: The ACO quality measure set spans four quality domains: Patient/Caregiver Experience, Care Coordination/Patient Safety, Preventive Health, and At-Risk Population. Each domain is 25 percent of an ACO’s quality score. The CAHPS for ACOs Summary Survey Measures (SSMs) comprise the Patient/Caregiver Experience domain. For more information on the Shared Savings Program quality measure set please see the Shared Savings Program quality webpage.
Shared Savings Program ACO quality scores and financial data are reported on Data.CMS.gov and Next Generation ACO Model quality and financial data is available on the Next Generation ACO Model website. Survey results may also be reported on Physician Compare and used in the Quality Payment Program (QPP), please visit the Physician Compare and QPP websites for additional information.
For more information about the CAHPS for ACOs survey, please visit the CAHPS for ACOs website: http://acocahps.cms.gov. You may also contact the CAHPS for ACOs project team at email@example.com.
Health Outcomes Survey (HOS)
Overview: The Medicare Health Outcomes Survey (HOS) is the first patient-reported outcomes measure used in Medicare managed care. The goal of the Medicare HOS is to gather valid, reliable, and clinically meaningful health status data from the Medicare Advantage (MA) program to use in quality improvement activities, pay for performance, program oversight, public reporting, and to improve health. All managed care organizations with Medicare contracts must participate.
About the survey: The HOS is administered annually to a random sample of Medicare beneficiaries drawn from each participating MA plan (i.e., a baseline survey is administered to a new cohort, or group, each year). Two years later, these same respondents are surveyed again (i.e., follow up measurement). The baseline sample size is twelve hundred. Cohort 1 was surveyed in 1998 and was re-surveyed in 2000. Cohort 20 was initially surveyed (baseline) in 2017 and re-surveyed (follow-up) in 2019.
The HOS was developed and continues to be refined under the guidance of a Technical Expert Panel comprised of individuals with specific expertise in the health care industry and outcomes measurement. HOS analysts apply the most recent advances in summarizing physical and mental health outcomes results and appropriate risk adjustment techniques. In addition to health outcomes measures, the HOS is used to collect three HEDIS® effectiveness of care measures: Management of Urinary Incontinence in Older Adults, Physical Activity in Older Adults, and Fall Risk Management.
Public reporting and policy relevance: Since 2012, several HOS measures have been included in the Star Ratings for MA Quality Bonus Payments. Beneficiaries may use HOS results to compare health plans. The public and research communities use results to assess MA program performance, to monitor the health of the Medicare population and vulnerable subgroups, and to evaluate treatment outcomes. MA contracts use HOS results to identify specific areas for quality improvement, and Medicare administrators and policymakers rely on the measures to monitor MA plans.
For comprehensive information about the Medicare Health Outcomes Survey program, please visit the CMS HOS website at http://hosonline.org. For information on how to gain access to HOS non-identifiable data, identifiable data, and limited data set files, please see the link to Files for Order in the Related Links inside CMS section below. For general and technical questions about the Medicare HOS, please contact HOS Information and Technical Support at HOS@hsag.com or (888) 880-0077. To ask a HOS program or policy question, please email firstname.lastname@example.org.
The Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey
Overview: The Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey captures the reasons Medicare beneficiaries voluntarily disenroll from their Medicare Advantage (MA) health and prescription drug plan (PDP) contracts. The Disenrollment Reasons Survey provides additional insight about reasons people leave their MA and PDP contracts beyond what disenrollment rates tell us. The survey excludes beneficiaries who involuntarily disenrolled from contracts for eligibility reasons, moved out of their contract’s service area, died, are Low Income Subsidy (LIS) beneficiaries reassigned by CMS, and those who switch from one plan benefit package to another under the same contract. Since 2013, CMS has surveyed beneficiaries who have voluntarily disenrolled from PDP and MA contracts.
About the survey: The PDP and MA Plan Disenrollment Reasons Survey is administered using three survey versions tailored to the type of contract the beneficiary left: 1) a stand-alone prescription drug plan (PDP) version; 2) a Medicare Advantage Prescription Drug (MA-PD) plan version; and 3) a Medicare Advantage (MA)-only version. A random sample of voluntary disenrollees from each contract is drawn monthly and surveyed as soon as possible following the beneficiary’s actual date of disenrollment. The sampled participants receive a pre-notification letter and up to two mailed survey packages (original and follow-up) within a 1-2 month window from time of disenrollment. The survey asks participants what reasons prompted them to disenroll from their contract including financial, drug or health benefits, customer service, and the coverage of doctors and hospitals by the contract.
Public reporting and policy relevance: Survey results are grouped into composite measures, so that the reasons given by disenrollees can be compared across contracts. Five composite measures are available: “Financial Reasons for Disenrollment,” “Problems with Prescription Drug Benefits and Coverage,” “Problems Getting Information and Help from the Plan,” “Problems Getting the Plan to Provide and Pay for Needed Care” and “Problems with Coverage of Doctors and Hospitals.” Data on these composite measures can be found at, http://go.cms.gov/partcanddstarratings in the annual Star Ratings Data Table and in the Display Measures .zip folder.
The survey results are used by contracts to identify areas in need of quality improvement and by Medicare administrators and policymakers to monitor the performance of Medicare plans.
For more information, please contact: DisenrollSurvey@cms.hhs.gov
Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS)
Overview: The Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) collects information about patients’ experiences of care in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). As of December 2012 there were approximately 5,357 Medicare-certified ASCs and about 3,360 HOPDs. In 2006, there were almost 35 million ambulatory surgical visits; approximately 20 million surgeries and procedures were performed in HOPDs, and approximately 15 million were performed in ASCs. Medicare payments to ASCs have increased by 24% over the years, from $2.9 billion in 2007 to $3.6 billion in 2012. Considering the growing number of ASCs and the increase in Medicare expenditures for outpatient surgical services in both ASCs and HOPDs, the implementation of OAS CAHPS will provide statistically valid data from the patient perspective to inform quality improvement and comparative consumer information about outpatient facilities.
About the survey: Patients 18 years old and older who had both medically and non-medically necessary surgeries and/or procedures are eligible. The survey includes questions about patients’ experiences with their preparation for the surgery or procedure, check-in processes, cleanliness of the facility, communications with the facility staff, discharge from the facility, and preparation for recovering at home. The survey also includes questions about whether patients received information about what to do if they had possible side-effects during their recovery. OAS CAHPS is designed to be national in scope and will require standardized administration protocols. There are three approved modes of administration: mail only, telephone only, and mail with a telephone follow-up.
Plans for a mode experiment to test a Web mode of administration: CMS is interested in investigating the feasibility of offering the survey using a Web-based format (see 82 FR 59216). As part of the investigation, CMS has designed a new mode experiment to assess the impact of adding Web-based survey administration. This mode experiment will test five administration modes with patients who receive outpatient surgical care: mail only, telephone only, web only, web with mail follow-up and web with a telephone follow-up. The mode experiment is planned for the Spring of 2019.
Public reporting and policy relevance: OAS CAHPS initiated voluntary national implementation in January 2016. The first publicly reported data were posted in 2018.
For more information, please visit the OAS CAHPS website: https://oascahps.org/. You may also contact: AmbSurgSurvey@cms.hhs.gov