CMS has stated that it wants to make changes to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS), perhaps offering an electronic survey option to address declining response rates.

CMS requested approval from the Office of Management and Budget to collect public feedback on possible changes to the mandatory survey for hospitals. (The notice is available online at:

The request asked that CMS be allowed to gather public comments on changes that could include an electronic version of the HCAHPS survey, which currently is conducted only by mail and/or phone.

Although hospitals must participate, the patient response rate for the 29-question survey is only 27%, according to the most current data. (The most recent HCAHPS data are available to review online at:

Response Rate Declining

The primary motivation behind evaluating this new approach is to increase capture of responses, according to Elizabeth Godsey, vice president for advance analytics and insights with Vizient. Response rate percentages are dipping lower than the average (mid to upper 30s). There are benefits to the current HCAHPS format, but allowing electronic surveys could bring additional advantages, Godsey explains.

“In the current survey method, there’s a level of rigor that ensures you’re only sampling the patient one time. These methods help maintain singular survey responses as well as a level of security for protected health information,” she says. “Currently, discharged patients have within 30 days to respond to mailed or phone surveys. A lot can change between the end of the discharge and the actual follow-up. Leveraging electronic surveys could allow for more timely and actionable feedback for providers than current methods.”

Electronic surveys also could allow the opportunity for a broader population of patients to be represented in the responses, Godsey adds.

Some Weaknesses to Address

The current system is not without its weaknesses. Providers are challenged to make improvements in the care they provide based on feedback that arrives at least one month after treating a patient. Further, that feedback represents the opinions of only a small subset of the patients who a provider saw, Godsey notes. “It’s really important to make the surveying process not only easy for patients, but also more valuable for providers,” Godsey says. “CMS is striving for a patients-over-paper approach to minimize patient and provider burden. Exploring electronic HCAHPS survey options would be a step in the right direction.”

Hospitals are yearning for more current, actionable, and comprehensive data. Quality improvement leaders might welcome the addition of electronic surveying, Godsey suggests.

“Having HCAHPS include an electronic patient experience assessment option would hopefully close the information gap between patients and providers, and could pave the way for more meaningful patient-provider experience,” she says. “Additionally, improving the quality and timeliness of HCAHPS data, which is used in CMS’ pay-for-performance measures, and coupling it with additional risk adjustment components, is essential in the how-do-we-improve-faster conversation.”

Potential Issues With New Approach

There are a few potentially problematic aspects to watch, Godsey cautions. How do providers ensure the protection of patients’ personal health information in an electronic format? How does one ensure the patient can access the electronic survey and that the process is easy to complete? How do survey facilitators ensure a patient does not respond multiple times? Does an electronic survey come through the vendor or the hospital? Is there a portal?

“I also wonder if there are any concerns around patients, such as older patients. Maybe they’re not as electronically savvy,” Godsey says. “Some patients, elderly patients, or patients with disabilities, may not necessarily have the same dexterity with electronic surveys or familiarity with electronic ways of providing feedback as they would paper or phone, as an example. These are all important questions for CMS to consider and address.”

Even if the request is approved, Godsey says there probably would be little immediate effect on hospitals and no need to change anything they are doing regarding quality scores. Hospitals do not administer the survey today and probably would not in the future, she says.

“There are vendors that they contract with to do this. For now, there isn’t anything that they need to change. When considering a new format, I think CMS should understand any financial impact to hospitals,” Godsey says. “If they’re shifting from paper or phone surveys to electronic surveys, is there any overhead or any extra costs that hospitals would incur for that? It should be a budget-neutral effort from the provider’s perspective.”