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Talking about CAHPS for Home Health and Hospice

The Q2 2016 PX Advisor is focused squarely on Non-Acute Care. This post excerpts an article By Karen Sorensen, Associate Vice President, National Initiatives, HealthStream, in which she takes a look at CAHPS from the viewpoint of home health and hospice care.

The CAHPS initiative has grown to include a range of surveys addressing nearly all aspects of the delivery system–acute and non-acute. In the years since that first CAHPS survey, the Centers for Medicare and Medicaid Services (CMS) and AHRQ have introduced multiple patient experience surveys, some of which are required and some of which are optional. In this Re-CAHPS article, we include the latest CAHPS news, and identify the key drivers on the Hospice CAHPS Survey that was introduced in 2015. We also take a look at the Home Health CAHPS and HCAHPS surveys to see if there are any lessons to be learned for post-acute providers.

Home Health CAHPS

CMS reports that response rates are falling for all CAHPS surveys, including Home Health CAHPS (HHCAHPS). Not surprisingly, the mixed methodology of mail followed by phone has the highest response rate (39.2%) and mail (30.7%) has the lowest. So, why do response rates matter? High response rates result in a lower margin of error and more reliable data. The HHCAHPS team offers some suggestions to improve response rates:
  • Ensure you are using appropriate languages for your patient base.
  • For mail surveys, make sure your logo and/or the name by which patients know the agency are on the envelope, the cover letter, and the questionnaire.
  • For telephone surveys, make sure the name of the HHA is the name that patients recognize.

Make sure patient addresses and phone numbers are accurate.


In addition to these recommendations, HealthStream recommends that agencies take a systematic approach to informing patients that they may be asked to participate in the survey. Your HealthStream Improvement Manager can share best practices on how to accomplish this and remain compliant with CAHPS protocols.

CMS also released the HHCAHPS Patient Survey Star Ratings in January 2016. The star ratings are designed to provide consumers a visual summary of the measures that are reported on the Home Health Compare website. Similar to the HCAHPS Star Ratings, CMS has also developed a summary star rating that combines all of the star ratings into a single metric. The CAHPS star ratings are in addition to the Quality of Patient Care Star ratings that were first reported in 2015.

Hospice CAHPS

HealthStream analysts looked at first 12 months of Hospice CAHPS data to identify the key drivers on this survey. Improvements made on items with the highest correlations generally translate into a higher score on the overall rating question. We asked Kathleen Lynam, an Executive Coach with the HealthStream Engagement Institute, if she was surprised by the findings. Lynam, a registered nurse, worked in the hospice and home health industries early in her career and served as the Vice President of Patient Care Services at a large hospital prior to joining HealthStream. Lynam pointed out that most of the questions on this survey focus on some aspect of communication (e.g., emotional support, training, and careful listening). Not surprisingly the drivers of the hospice experience are closely centered on these aspects of care. Lynam explains, “In the hospice setting, most family caregivers are novices, meaning they have never experienced this role before. They rely heavily on the hospice team to not only provide training on how to position, clean, feed, and care for their loved one, but also on what to expect during the dying process. Family members have huge learning needs, not just for themselves and their own ability to do the required tasks, but also for how to care for and support their loved one.


Data Observations from Home Health CAHPS and HCAHPS

Now that Home Health Value-Based Purchasing (HHVBP) is becoming a reality, agencies have an increased interest in their HHCAHPS Survey results. The HealthStream analytics team compared HCAHPS and HHCAHPS to see if there are any lessons to be learned. The infographic on the next page shows that HCAHPS scores have steadily risen from a low of 67% in 2008 to 73% with the last public reporting. HHCAHPS top box scores (84%) have remained high and stable in comparison. There has been no change in the top box scores over the three annual public reporting periods. For Kathleen Lynam the high HHCAHPS scores come as somewhat of a surprise. “The unlicensed home care worker is the most transient and least stable role. Yet these are the workers who have the most exposure to the patient and the greatest potential impact on the patient experience. It’s unexpected to see these scores so high.” Lynam says. What is less of a surprise for Lynam is that the key drivers on both surveys are centered on communication–responsiveness, careful listening, courtesy and respect. Improvements in these areas will have the greatest impact on the overall patient experience. 

HHCAHPS scores are highest among the HHAs that are hospital-owned. However, Lynam says the relationship between acute care and home health care is at best fragmented. As CMS expands the hospital readmissions “net” it will be critical for hospitals and HHAs to better collaborate in keeping patients out of the hospital. Many have credited the Hospital Value-Based Purchasing Program with driving the improvement in HCAHPS scores. But will the HHVBP program have the same impact for HHAs, where resources are much more limited? Since the inception of HCAHPS, hospitals have made a great investment in improving communication, listening, empathy, and patient education. We have not seen the same focus on the post-acute side, largely because of financial constraints. Nevertheless, Lynam says she is hopeful that the focus on the patient experience will become as embedded in the culture as it has in the acute setting.