HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems
HCAHPS is the first national, standardised, publicly reported survey of patients' perspectives on hospital care, with 10 measures incorporated into the CMS Value-Based Purchasing programme to determine hospital payment adjustments.
What is HCAHPS?
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed by CMS and the Agency for Healthcare Research and Quality (AHRQ) and implemented nationwide in 2006. It is a 29-item survey administered to a random sample of adult patients between 48 hours and 6 weeks after hospital discharge. HCAHPS results are publicly reported on the Hospital Compare website and directly influence hospital reimbursement through the CMS Hospital Value-Based Purchasing (VBP) programme.
The 10 HCAHPS Composite Measures Used in VBP
- Nurse Communication
- Doctor Communication
- Responsiveness of Hospital Staff
- Communication about Medicines
- Discharge Information
- Care Transition
- Cleanliness of Hospital Environment
- Quietness of Hospital Environment
- Overall Rating of Hospital (0–10)
- Willingness to Recommend the Hospital
Minimum Sample and Response Rate Requirements
To have HCAHPS results publicly reported, hospitals must have a minimum of 100 completed surveys over the 12-month reporting period. Response rates vary widely — national average is approximately 25–27%. Low response rates introduce sampling bias and increase score volatility. Hospitals are assessed on their adjusted survey results, which account for factors outside the hospital's control (patient mix differences such as age, education, service line, and native language).
HCAHPS Star Ratings and VBP Financial Impact
CMS assigns HCAHPS Star Ratings (1–5 stars) for each of the 10 measures and a Summary Star Rating. The Patient Experience of Care domain constitutes 25% of the CMS Hospital VBP Total Performance Score in FY2024, which determines payment adjustments of up to ±2% on Medicare base operating DRG payments. For a hospital receiving $100M in annual Medicare inpatient payments, HCAHPS-driven VBP adjustments can represent ±$2M annually.