What is the CAHPS survey?

The CAHPS survey is intended to measure the experience of patients who had died while receiving hospice care and the experience of their primary caregivers.  It surveys informal caregivers – usually family members – of the persons who died under hospice care.

The survey is a component of the Hospice Quality Reporting Program (HQRP). It is an experience survey rather than a satisfaction survey. The intention of this survey is to provide data that can be publicly reported on Care Compare. It is also intended to provide hospice agencies with data for quality improvement.

How and when is the survey conducted?

To give the caregiver some time for recovery, the survey is administered to the primary informal caregiver of those who died while receiving hospice care at least two months following the month of the patient’s death.

The survey is conducted by mail, by telephone, or by mail with telephone follow up, at the hospice agency’s preference.

How are survey responses reported on Care Compare?

The survey is comprised of 47 questions. Not all of the respondents answer all of the questions and not all of the survey responses are publicly reported. Instead, some of the responses are aggregated together to generate a composite measure that is reported to the public. The result is that eight measures are publicly reported:  six composite measures comprised of responses aggregated across multiple questions and two single item measures.

Composite measures:

• Communication with the family
• Receiving timely help
• Treating the patient with respect
• Emotional and spiritual support
• Help for pain and symptoms
• Training the family to care for the patient

Single item measures

• Ratings of the hospice
• Willingness to recommend the hospice

Which hospice agencies must participate in the CAHPS Survey?

Any Medicare certified hospice agency that served at least 50 survey eligible hospice patients in the previous calendar year and that received its CCN after January 1 of the previous calendar year is required to participate in the CAHPS Hospice Survey. The hospice agency is required to successfully submit 12 months of data, from January through December, of the data collection year. Failure to participate will result in a 2% penalty from Medicare payments.

Which agencies are exempt from participating in the survey?

• Newness Exemption: A hospice that receives its CCN on or after January 1 is eligible for a one-time exemption from the CAHPS survey for the remainder of that calendar year. For example, a hospice agency that receives its CCN in 2022 will be required to participate in the CAHPS survey beginning with patients who die in January 2023, unless the agency meets the Size Exemption
• Size Exemption:  A hospice agency can apply for an exemption from the CAHPS survey if the agency served fewer than 50 survey eligible patients or caregivers in the prior calendar year. If multiple facilities share a single CCN, the survey eligible patients count is the total from all facilities that share the same CCN.  The form to apply for the exemption, submission deadline, and further details on exemption, can be found here

Who administers the CAHPS Hospice Survey?

A hospice agency is not permitted to directly administer the CAHPS hospice survey. Instead, the agency is required to use a CMS approved survey vendor to administer the CAHPS surveys on an ongoing monthly basis.

Where are these results reported?

All eight CAHPS quality measures are publicly reported. They are all also available in the CASPER Preview Reports so that a hospice agency is able to review the data before it is publicly reported on Hospice Care Compare.

May a hospice communicate with its patients and their caregivers about the survey?

If a hospice agency wishes to let its patients know about the CAHPS survey, it must notify all patients about the survey rather than selectively notifying patients. Additionally, the agency cannot try to influence the survey responses or ask caregivers to give certain ratings. 

How does CMS adjust the data that is submitted?

The data is case mixed adjusted. That is, CMS tries to remove the effects that arise from the demographics of the patients served by each hospice agency. The intent is to make the scores more comparable across hospice agencies.  Data that a hospice agency may receive from its survey vendor may not be case mix adjusted. Consequently, the data that a hospice agency receives from its survey vendor may not match the data that it sees in the CASPER Preview Report or on Hospice Care Compare.

Can a hospice agency review its data before it is publicly reported?

CMS provides a 30 day review period during which providers can use the Hospice CAHPS Provider Preview Report to review their CAHPS data before it is publicly reported on Care Compare.  This report can be accessed on CASPER.  If a hospice agency finds an error in the data after review the Preview Report, it may request that CMS review the data by submitting a request to the following address hospicecaphssurvey@hsag.com.  However, all requests for review must be submitted within 30 days of release of the Preview Report.  Detailed instructions for requesting a review of the data can be found here

Where can you find more information?

• AHRQ description of the CAHPS survey:  CAHPS Survey – AHRQ
• CMS description of the CAHPS survey:  CAHPS Survey – CMS
• Approved hospice CAHPS vendors:  CAHPS – vendor list
• Must every hospice participate in the CAHPS hospice survey?
• Selecting a CAHPS Hospice Survey Vendor