Developing a Pain Initiative Under the Current HCAHPS Care Survey

Author: Jeffrey A. Gudin

The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS (pronounced "H-caps") is measured by data collection through a survey instrument in which patients' opinions of their hospital experience is evaluated. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally. With at least 2 questions focused on pain, it is obvious that pain management will contribute to the overall rating and weight that these surveys carry. The purpose of this article is to define the relatively recent HCAHPS survey and its role in enhancing not only healthcare accountability, but also transparency of the quality of hospital care. It identifies changes in professional practice and hospital culture that should impact the likelihood that patients will choose the positive "always" when answering pain HCAHPS survey questions.

Hospitals are no longer paid solely on the quantity of services they provide. The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries. CMS rewards hospitals based on the quality of care provided to Medicare patients, how closely best clinical practices are followed, and how well hospitals enhance patients' experiences of care during hospital stays.

The HCAHPS survey is designed to report data about patients' perspectives of care to allow objective and meaningful comparisons of hospitals on topics important to consumers. HCAHPS also promotes public reporting of the survey results and creates incentives for hospitals to improve quality of care. CMS and the HCAHPS Project Team have taken substantial steps to assure that the survey is credible, useful, and practical. HCAHPS survey is administered to a random sample of adult patients with various medical conditions between 48 hours and 6 weeks after discharge; the survey is not restricted to Medicare beneficiaries. It is 32 questions in length and asks discharged patients questions about their recent hospital stay. The survey contains 21 patient perspectives on care and patient rating items that encompass 9 key topics.

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