CAHPS is an abbreviation for the Consumer Assessment of Healthcare Providers and Systems and the survey for Home Healthcare is commonly referred to as HHCAHPS. It is a 34-question standardized survey that is administered by an official vendor with some of the results publically reported. This allows consumers to review and compare patient satisfaction with services provided by agencies to make an informed choice for their healthcare needs. All Medicare-certified home health agencies who serve 60 or more patients in a year must participate in HHCAHPS. Newly certified agencies, who receive Medicare certification after the cutoff date for the period, are given a one-time exemption without needing to submit an exemption form.

How do patients get selected for surveys?

Agencies submit patient reports to the HHCAHPS vendor making sure to include all patients who are over 18 years of age, covered by Medicare, Medicaid and/or Medicare Advantage, and who have received at least one SN, PT, OT or SLP visit in the sample month. Agencies then exclude patients who are deceased, currently receiving hospice care, receiving home health care only for maternity services, those who request their name and contact information not be released to anyone other than the agency, and patients who must be excluded according to their state’s privacy regulations (for example, patients who have HIV/AIDS).

The HHCAHPS survey vendor then selects random patients according to complex statistical formulas and ensuring that eligible patients receive surveys at least six months apart. The vendor administers the surveys either by mail or phone, follows up with patients who do not respond, and compiles the results to report to CMS and the home health agency.

How do I start?

First you need to determine whether your agency is required to participate in the HHCAHPS program. If your agency served less than 60 eligible patients in the period between April 1st and March 31st of the prior year, you can find more information about the exemption on the official HHCAHPS website. If you are not exempt, you must choose an approved HHCAHPS survey vendor. Make sure you contact several vendors, find out about pricing, what their processes are, request report samples, and inquire about any extra reporting capabilities they have. Once you have designated a HHCAHPS vendor, you can only change at the beginning of each calendar quarter.

Determine a HHCAHPS Survey Administrator for your agency and have that person register for login credentials. Once you have a Survey Administrator set up, they will be able to add and remove vendors and monitor CMS submission data to ensure your vendor is reporting promptly and your agency remains in compliance.

What can I see in the reports?

The survey is divided into four sections: “Your Home Health Care”, “Your Care from Home Health Providers in the Last 2 Months”, “Your Home Health Agency”, and “About You”. You can find a sample of the survey in the Questionnaire section of Survey Materials on the same official HHCAHPS website. Your survey vendor will provide all of the data results with the possible exception of “About You” responses. This is because it could be difficult to protect the anonymity of respondents if your patient population is not very diverse (for example, if you only submitted one Asian patient in your sample, you could very easily identify the responses that patient submitted). Some vendors will also provide comparisons of your patient satisfaction numbers compared to other clients’ summary numbers.

The publically reported results are available via the Home Health Compare website. We will cover Home Health Compare in more detail in one of our follow-up posts. On the Home Health Compare website, the “What items are on the patient experience of care survey?” section details the questions that determine the performance numbers.

Using reports for QAPI

The HHCAHPS survey responses give you a good insight into how your patient views their care. If your vendor has the capability of reporting by region or case manager, you can use your data to identify clinicians or groups who may need some additional education in communicating with patients, assessing their level of understanding and satisfaction, and ensuring that care includes addressing medication, pain and home safety.

After Identification

If you choose to use HHCAHPS data in your surveys, it is important to keep in mind that survey results are going to take time to compile. For example, if you are looking at patients who received care in May, 2018, you will submit the patient data to the vendor within about 10-15 days after the end of the month. The vendor must start the survey process within 21 days of the end of the month (by 6/21/2018) and complete the process within 42 days of the day it started (by 8/2/2018 at the latest). So complete results for a sample month could take about two and a half months to compile and report.

If you would like to get an idea about how your clinicians are doing more frequently, you can ask patients about the care they are receiving. However, there are very strict rules for the agency to follow as far as selecting which patients to contact and what questions you may ask. Carefully review “Communications With Patients About the HHCAHPS Survey” and “Administering HHCAHPS in Conjunction With Other Surveys” on pages 13-15 of the Home Health Care CAHPS Survey Protocols and Guidelines Manual, available as PDF via this direct link, to make sure you stay in compliance.

More Information

If you would like more information about HHCAHPS, check out the official website and their list of manuals and materials. You can also find information about HHCAHPS on the AHRQ website. AHRQ is the Agency for Healthcare Research and Quality working under the US Department of Health & Human Services to improve safety and quality of healthcare. To submit questions about this article, connect with us on Facebook.