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HCAHPS: What Hospital Patients Care About the Most

Patient experience has taken on new importance in recent years due to new CMS quality and reimbursement initiatives. Today, many hospitals’ Medicare payments are determined in part by their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, a standardized program through which patients rate hospitals on 11 key measures. Two of the domains, the percentage of patients who scored their stay at 9 or 10 out of 10 and willingness to recommend the hospital, deserve some attention as they represent qualitative judgements of the entire patient experience. Given their importance to a hospital’s performance in some CMS programs and general reputation, it’s critical for hospitals to identify what specific aspects of a patient’s experience have the most influence on their overall ratings. An analysis of the most recent hospital HCAHPS scores suggests that not all measures have the same degree of correlation to a patient’s numeric rating and recommendation.

To determine the correlation between the measures, the roughly 4,000 scored hospitals were ranked by decile, once by the percentage of patients who gave a 9 or 10 rating, and again by percentage who would recommend the hospital. The difference between the median scores of the top and bottom deciles for each measure indicates the overall correlation to either of the two qualitative measures. A domain with a large difference would be a greater driver of the qualitative score, assuming that all measures had an equal effect on a patient’s rating, whereas a small difference suggests the measure was less significant. The median scores for all measures decreased steadily by decile, also suggesting that each of the domains had an effect on the overall rating. The differences by measure can be seen in the tables below. The percentages reflect the number of respondents who agreed with the measure description as it applied to their experience.

Median HCAHPS Score Differences, Ranked by 9 or 10 Score

Top Decile Bottom Decile Difference
 Nurse Communicated Well  89% 72% 17
 Doctor Communicated Well  88% 75% 13
 Hospital Staff Were Responsive  81% 57% 24
 Pain Well Controlled  78% 64% 14
 Staff Explained Medications  73% 57% 16
 Room, Bathroom Clean  84% 66% 18
 Always Quiet at Night  74% 53% 21
 Given Discharge Information  91% 83% 8
 Understood Care Transition  62% 43% 19

Source: Definitive Healthcare data

Median HCAHPS Score Differences, Ranked by Willingness to Recommend

Top Decile Bottom Decile Difference
 Nurse Communicated Well  87% 74% 13
 Doctor Communicated Well  87% 76% 11
 Hospital Staff Were Responsive  79% 60% 19
 Pain Well Controlled  77% 65% 12
 Staff Explained Medications  72% 58% 14
 Room, Bathroom Clean  82% 67% 15
 Always Quiet at Night  72% 55% 17
 Given Discharge Information  91%  84% 7
 Understood Care Transition  62% 43% 19

Source: Definitive Healthcare data

The differences between the top and bottom decile median measures are fairly consistent across both categories, and the individual domains generally follow the same order. Given Discharge Information and Doctor Communicated Well have the lowest differences between deciles, while Understood Care Transition, Always Quiet at Night, and Hospital Staff Were Responsive showed the greatest variation. Some of the differences could be explained by hospital size. Generally, hospitals with fewer staffed beds and annual discharges were ranked in higher deciles in both groups. A smaller hospital is usually quieter and among private hospitals, tends to have a lower case mix, which would put less strain on nurses and possibly reduce response time. The effect of hospital size on measures such as patient understanding of post-discharge instructions and room cleanliness are less clear, however.

Just as some aspects of patient experience seem to be more influential than others, some aspects are more difficult to improve upon. Noise levels may be beyond the control of some hospitals, such as major urban trauma centers with high volume and space constraints. Other organizations may not be able to afford the necessary staffing to improve patient response times. Even so, poor performance in other domains may be easier to fix. Though most hospitals issue post-discharge care instructions, the scores suggest that many patients fail to understand them. Greater emphasis on care transitions, such as hiring additional staff or taking more time to explain instructions prior to discharge, could both improve patient experience as well as reduce preventable readmissions. Hospitals must continue to make smart investments in patient experience where they can.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our databases included detailed information on a wide variety of quality measures, including HCAHPS, readmissions, Value-Based Purchasing, and more.

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