In a recent final rule, CMS confirmed several changes for HCAHPS guidelines as a result of observations from the 2021 HCAHPS mode experiment. These changes are listed below and CMS plans for them to begin with discharges from January 1st, 2025, forward.
- Survey Modes of Data Collection
- In response to growing demand for cost-effective internet-based options, CMS will allow hospitals to use new mixed-modes consisting of: Web-Mail, Web-Phone, Web-Mail-Phone. (These same options have been approved for the official OAS CAHPS implementation.) In the mode experiment, these web-first modes yielded improved response rates, a long-standing goal for CMS. Phone-only, mail-only, and mail-phone are still approved.
- With no hospitals using IVR since 2016, CMS will eliminate this survey mode.
- Data Collection Period
- To accommodate the new mixed-mode options, CMS will extend the data collection period after first contact from 42 to 49 days, to allow adequate time for secondary mode outreach. The 2021 mode experiment also found a statistically significant increase in completed surveys from underrepresented groups during the day 43 to 49 period.
- Limit on Supplemental HCAHPS Questions
- National survey response rates have been on the decline and appear to decrease as the number of supplemental items increase. CMS is implementing a new rule to limit the number of supplemental questions to 12, to prevent survey length from negatively impacting response rates. This limit is consistent with other CAHPS surveys. PRC will review the count of supplemental items and reach out to hospitals who are currently over that amount.
- Spanish Translation for Survey
- Hospitals will be required to collect the preferred language or language spoken at home from every patient and provide this field in the data file.
- Vendors will be required to administer the Spanish translation of the survey to all Spanish language-preferring patients.
- Proxy Respondents
- CMS will allow proxy respondents to complete the HCAHPS survey on behalf of a patient, but still wants to encourage patients to respond when feasible.
- CMS has received ongoing feedback from stakeholders asking for proxies to be permitted, and in the 2021 Mode Experiment, they found that allowing proxies respondents did not impact HCAHPS scores.
- We expect to have more information on who will be allowed to serve as a proxy and how this will be implemented in the next Quality Assurance Guidelines in March of 2024.
Additionally, the final rule noted the exclusion from the HCAHPS survey for patients with a primary psychiatric diagnosis will continue. CMS plans to continue to evaluate the best way to add patients with a primary psychiatric diagnosis to evaluate the patient experience for this care setting.
The 2021 HCAHPS mode experiment tested new survey content, but no survey changes were included in this proposed rule. Potential survey changes will be submitted to a review and endorsement agency in 2023 and may be proposed in future rulemaking.
We will continue to monitor and communicate any new information released by CMS on the upcoming changes for HCAHPS 2.0. The Quality Assurance Guidelines will contain information on how to implement these changes and is expected in March 2024.
If you have more questions about this final rule, please reach out to our CAHPS® team at [email protected].