1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: I'm not sure that I completely understand what the HCAHPS survey means for point-of-care nurses? Can you briefly explain its impact?

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A: The publicly reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' perceptions of their hospital experience. Key indicators are used to gauge patient engagement and, ultimately, satisfaction. Additionally, the standardized methodology allows you to see where your organization places both locally and nationally compared with other facilities of similar size, acuity, and services.


Consisting of 32 questions, the HCAHPS survey is distributed on an intentionally random basis. Of these questions, 18 are referred to as "core" questions focused on nurse and physician communication; hospital environment, such as cleanliness and quiet; pain management; discharge instructions; medication education; the overall rating of the hospital; and the patient's willingness to recommend the hospital to others. The survey is available in several languages to provide broader viewpoints and can be completed via phone, e-mail, or mail.


In 2018, the current HCAHPS survey questions regarding pain management will be replaced with three new questions. This decision is due, in part, to the opioid crisis; the existing three pain management questions are perceived as encouraging medication for pain. The three new questions will focus on patient perception of pain and communication about pain.


The HCAHPS survey is now deeply embedded in our healthcare and quality expectations. It was included in the Affordable Care Act of 2010, which was then linked to pay-for-performance initiatives in 2012. This has a huge impact on organizations because we're now reimbursed not for services rendered, but based on the quality of those services and patient outcomes.


Does the HCAHPS survey really drive quality? There's a concern that patients may be overtreated as hospitals try to keep their reimbursements from diminishing. According to one survey, 47% of physicians reported having at least one patient per week request an unnecessary test. More than half indicated that they ordered an unnecessary test for a demanding patient. The provision of what some refer to as hotel-like expectations may contribute to the rising cost of healthcare.


Today, healthcare organizations rely heavily on HCAHPS scores, usually introducing them during orientation and at least annually in educational sessions. Both The Joint Commission and the Centers for Medicare and Medicaid Services focus on these scores, along with other quality measures, during their site visits. It's important for us to understand the survey, its purpose, and our role in ensuring patient satisfaction outcomes. Engage in the process and get to know how your organization ranks locally and nationally.




Centers for Medicare and Medicaid Services. HCAHPS: patients' perspectives of care survey. https://


Manwaring A. How HCAHPS scores and Medicare/Medicaid reimbursement affect nursing care.


Murphy M. HCAHPS: the true impact of patient satisfaction.