Don't wait any longer: HH-CAHPS is around the corner

Select vendor and test survey before October 2010

Home health managers got a little breathing room when the Centers for Medicare & Medicaid Services (CMS) announced a delay in the implementation requirements for the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HH-CAHPS). Many providers needed the additional time to focus on implementation of OASIS C [Outcome and Assessment Information Set], which was initiated in January 2010.

"OASIS C required so much staff education, revision of software, and preparation for implementation that many home health agencies could only focus on [that]," says Sue Squibb, BSN, director of consulting services for The Corridor Group in Overland Park, KS. With OASIS C directly affecting the agencies' reimbursement, it is no surprise that agencies with limited staff and financial resources focused on it first, she adds.

Now, agencies should be into their preparation to collect and report the standardized patient satisfaction data required by CMS, Squibb warns. "Right now, and in the foreseeable future, participation in HH-CAHPS is voluntary, but it is reasonable to assume that patient satisfaction ratings will ultimately be a part of any pay-for-performance model," she adds. Although it is voluntary at this time, agencies with more than 60 Medicare patients per year that do not participate will receive a 2% reduction in their annual market basket updates, she points out. Agencies with fewer than 60 patients during the year can apply for a waiver, she adds.

Home health agencies should be contracted with an approved vendor to survey patients and collect and report the data by June 2010, suggests Squibb. Each agency should conduct a test run of the survey for at least one month during the third quarter of 2010 and begin to collect data on an ongoing basis in October 2010. "Starting in October 2011, four quarters of data at a time will be publicly reported," she says. The results will be reported on the Home Health Compare web site.

Preparation for HH-CAHPS was a little easier for Aseracare than it may be for other home health agencies. "We have been using an outside vendor for patient satisfaction measurement for several years, and the company is approved by CMS for HH-CAHPS," says Nancy Ponder, RN, national director of clinical operations and quality management. In spring 2009, Ponder started looking at the requirements for HH-CAHPS and consulted with the existing vendor to confirm that the company could support Aseracare's needs to meet the requirements. "The vendor is adding questions that are required by CMS to our existing survey, so we will be ready to collect and report the data CMS has specified," she adds.

Small agencies may face some expenses

"Smaller programs that have been using homegrown surveys to measure patients' satisfaction may find the requirements scary, because they perceive use of an outside vendor as expensive," admits Squibb. "If they do their homework and factor the full cost of printing, mailing, and personnel labor ... to develop, distribute, and report the data in-house, the use of an outside vendor might not be as expensive as first thought," she says.

Not only will an outside vendor take over some of the time-consuming aspects of patient satisfaction surveys, but also vendors approved for HH-CAHPS are up to date with the changes in CMS requirements. "A good vendor will take the worry out of the process," Ponder says.

Look for a vendor that will add agency-specific questions and develop reports that fit your internal needs, but don't try to do too much at the beginning, suggests Squibb. "Most vendors are suggesting that home health agencies make sure they are meeting CMS requirements first, then adding custom features later," she says. This keeps the preparation process simple, because CMS has a standard questionnaire that must be used, she adds.

Work with your vendor to determine how many surveys must be mailed to patients to guarantee the minimum 300 responses per year required by CMS, suggests Squibb. "Most vendors project a 30% return rate for mailed surveys, so agencies need to decide if they want to send more than needed to ensure the proper number of responses," she says. Smaller agencies may choose to send surveys to 100% of patients, she adds.

When selecting a vendor, make sure the company has specific home health experience and ask to talk with current home health clients to make sure the company meets deadlines, suggests Squibb. "I recommend that an agency get three proposals to compare before selecting a final vendor," she says. When looking at survey costs, keep in mind that mailed surveys are the most cost-effective, she adds.

Don't forget to let all of your staff members know about the survey and its importance to the agency, suggests Squibb. "Let staff members see the survey, learn how it will be distributed, and talk about customer service," she says.

Even with the preparation and financial investment in preparing for and meeting HH-CAHPS requirements, this is a program that is good for home health, says Squibb. "It will provide a national database that enables home health agencies to compare their patient satisfaction results with others, and vendors will be able to provide best practice information," she says.

If a home health manager finds that the cost of participating in HH-CAHPS is greater than the 2% reduction in the agency's market basket update, there is always the option to decide not to participate and to accept the reduction, points out Squibb. "I don't recommend that an agency that makes this decision become comfortable opting out," she says. "I have no reason to believe that at some point in the future it will be mandatory for any home health agency that accepts Medicare patients."

Resource & Sources

• For information about the Home Health Care Consumer Assessment of Healthcare Providers and Systems requirements, go to The site contains the list of approved vendors, the survey questionnaire, updates on the program, and other valuable tools for home health agencies to use in implementation.

For more information about HH-CAHPS, contact:

• Nancy Ponder, RN, National Director of Clinical Operations and Quality Management, Aseracare, 30 Perimeter Park Drive, Atlanta, GA 30341. E-mail:

• Sue Squibb, BSN, Director of Consulting Services, The Corridor Group, 6405 Metcalf St., Suite 108, Overland Park, Kansas 66202. Telephone: (415) 452-4383. E-mail: