In 2002, the Centers for Medicare & Medicaid Services (CMS) mandated a nationwide survey program, Consumer Assessment of Healthcare Providers and Systems (CAHPS), aimed at quality improvement in healthcare. The initiative focused on empowering healthcare consumers with quality of care information to help them make informed decisions when choosing a provider. The initiative also encouraged providers and clinicians to improve the quality of healthcare by making quality of care data publically available.
CAHPS serves as a primary vehicle for collecting and publishing data on patient experiences with healthcare. CAHPS adopts the same principles of rating and comparison shopping found in other consumer industries such as computer products, restaurants and entertainment. CAHPS provides healthcare consumers with a wealth of information on a number of qualities of care metrics specific to healthcare. Thus, consumers can readily access quality of care information in order to comparison shop and ideally find a provider best suited to their needs. Compiling this type of information, allows consumers to make choice of care decisions intelligently by selecting a high rated provider. In addition, by making quality of care information readily available to consumers a built-in incentive is provided for health care providers to improve their quality of care or lose their competitive advantage.
Although initially restricted to nursing homes, CMS expanded the CAHPS program in 2012 to home healthcare providers with the implementation of the Home Health Care CAHPS Survey (HH CAHPS). Much like its predecessor, HH CAHPS measures the experiences of home health care services from Medicare-certified home health agencies. According to CMS, HH CAHPS is intended to meet the following three broad goals:
- To produce comparable data on the patient’s perspective that allows objective and meaningful comparisons between home health agencies on domains that are important to consumers.
- Public reporting of survey results will create incentives for agencies to improve their quality of care.
- Public reporting will enhance public accountability in health care by increasing the transparency of the quality of care provided in return for public investment.
Although not all home healthcare agencies are required to participate in the program, those that voluntarily participate and those that are required to participate must be Medicare-certified; contract with an approved HH CAHPS Survey vendor (a list of approved survey vendors is available on the CAHPS website); register on the home healthcare agency private and secure site at CAHPS; and authorize an approved survey vendor on CAHPS to submit data for that home healthcare agency.
The HH CAHPS survey instrument involves 34 closed-ended multiple-choice questions over the following five broad subject areas:
- Gave care in a professional way
- Communicated well
- Discuss medications, pain and home safety
- Overall satisfaction
- Recommend to friends and family
The questions provide a straightforward measure of quality of care, thus enabling consumers and providers to understand the strengths and weaknesses in service delivery. The instrument is user-friendly, for both consumers to complete and providers to interpret. This allows for data to be aggregated and analyzed without a great deal of statistical analysis.
As mentioned above, one of the primary functions of HH CAHPS involves publicly reporting survey results to allow consumers to comparison shop for care. Consumers can view an individual agency’s results and compare them with state and national averages.
From the provider’s perspective, HH CAHPS provides two benefits. The first rests in the ability to do business based on quality care. Like in other industries, quality of service and public perception of service delivery helps hold agencies accountable for their level of quality. Prior to publically available data, the only information healthcare consumers could obtain was from negative reports published in the media. The nuanced data surrounding quality of care was relatively unavailable unless provided through word of mouth references. With the HH CAHPS program, home health care agencies with favorable ratings can use the ratings in marketing efforts. Providers with a publically available and verifiable record of quality care can point potential consumers to this fact to encourage them to choose their agency.
A second benefit involves using HH CAHPS data to internally monitor the quality of care being provided. By allowing providers to analyze the strengths and weaknesses in service delivery, they can develop corrective action plans to address deficiencies. In the end, the data can serve as a component of the provider’s larger risk-management strategy. Given the comparative nature of the data, providers can also measure their performance against regional benchmarks and against the competition. In an increasingly competitive marketplace, conducting business on quality of care often can be the difference between thriving and failing.
The staff at Concepts in Eldercare in Boca Raton, Florida, is finding the survey results very valuable. Administrator Holly Boise says they discuss the CAHPS data in their weekly staff meetings and board meetings and take corrective action. One survey identified an opportunity to address a medication process. “We communicated this to staff and reviewed the Medicare requirements with them. The CAHPS surveys have helped us be more compliant and continuously monitor our quality of care,” she said.
It is clear HH CAHPS will play an increasing critical role as CMS continues to require CAHPS in other areas such as hospice, in center dialysis and emergency rooms. Beginning in 2012, the Patient Protection and Affordable Care Act (P.L. 111-148) required the Hospital CAHPS performance be included in the calculation for value-based incentive payments in the Hospital Value-Based Purchasing program. Although it is unclear whether this will serve as a model in the future for CAHPS in other areas in healthcare, one thing is clear – HH CAHPS is here to stay and agencies should adopt and utilize it fully.
