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August 2017
Why do CAHPSSM and HOS surveys matter?
Providing a positive patient experience not only improves patient outcomes, but it also simply makes good business sense.
What are CAHPS and HOS?
The Consumer Assessment of Healthcare Providers and Systems and Health Outcomes Survey are patient-experience surveys developed by the Centers for Medicare & Medicaid Services.
CAHPS and HOS surveys ask patients to rate experiences with their health care providers and health care plan. The questions focus on how patients experienced or perceived key aspects of their care — not how satisfied they were with their care.
The annual surveys are sent to a sampling of Medicare Advantage members by a certified survey vendor.
- CAHPS measures members’ satisfaction with their overall health care experience. The survey covers the following areas:
- Health care in the last six months
- Personal doctor
- Getting health care from specialists
- Health care plan
- Medicare rights
- HOS measures patient-reported health outcomes:
- It asks a random sampling of Medicare Advantage plan members about their health and the quality of the health care they received.
- The members are surveyed two years after their experience to determine any changes in their self-reported health status.
Why are CAHPS and HOS important?
- A good patient experience is associated with positive clinical outcomes.
- A good patient experience has a positive effect on processes of care for both prevention and disease management. For example, diabetic patients demonstrate greater self-management skills and quality of life when they report positive interactions with their health care providers.
- Patients’ positive experiences with care can result in adherence to medical advice and treatment plans. This is especially true for patients with chronic conditions where a strong commitment from patients to work with their physicians is essential to achieving positive results.
- Patients with better care experiences often have better health outcomes. For example, studies of patients hospitalized for heart attacks showed that patients with positive reports about their care experiences had better health outcomes a year after discharge.
- Measures of patient experience can reveal important system problems, such as delays in returning tests results and gaps in communication that may have quality, safety and efficiency implications.
- Improving patient experience is good business because it correlates with key financial indicators.
- A good patient experience is associated with a lower medical malpractice risk. A 2009 study** found that for each drop in scores on a five-point scale of “very good” to “very poor,” the likelihood of a provider being named in a malpractice suit increased by 22 percent.
- Good patient experience results in greater employee satisfaction and less employee turnover. Patients usually keep or change providers based on their experience — and the quality of their relationship with the provider’s staff is a major predictor of patient loyalty.
What are the CAHPS and HOS questions?
Survey name and measure |
Survey question to patient |
Recommendation to provider where applicable |
CAHPS: Annual flu vaccine |
Have you had a flu shot since July 1, 2017? |
Administer flu shot after July 1, 2017 and before Feb. 1, 2018. |
CAHPS: Getting appointments and care quickly |
In the last six months:
- How often did you see the person you came to see within 15 minutes of your appointment time?
- When you needed care right away, how often did you get care as soon as you thought you needed it?
- Not counting the times when you needed care right away, how often did you get care as soon as you thought you needed it?
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- If you’re behind schedule, have the front office staff update patients often and explain why. Patients are more tolerant of delays if they know the reasons.
- Show respect to the patient if you’re behind schedule and apologize.
- Ensure that a few appointments are open each day for urgent visits, including post-inpatient discharge visits.
- Offer appointments with a nurse practitioner or physician’s assistant to patients who want to be seen on short notice.
- Ask patients to make routine check-up and follow-up appointments in advance.
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CAHPS: Overall rating of health care quality |
Using any number between zero and 10, where zero is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the past six months? |
Ask patients how they think you should improve their health care. |
CAHPS: Care coordination |
- When you visited your personal doctor for a scheduled appointment, how often did he or she have your medical records or other information about your care?
- When your personal doctor ordered a blood test, X-ray or other test for you, did someone from your personal doctor’s office follow up to give you those results?
- Did your personal doctor talk to you about all the prescription medicines you were taking?
- Did you get the help you needed from your personal doctor’s office to manage your care among these different providers and services?
- How often did your personal doctor seem informed and up to date about specialist care?
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- Before walking in the exam room, read the current complaints and determine if anything needs a follow-up from previous visits.
- When ordering tests, let your patients know when they can expect results. Implement a system to ensure timely notifications of results.
- Ask your patients if they saw another provider since you last met with them. If you know patients received specialty care, discuss their visit and if the specialist prescribed any additional medication.
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HOS: Improving or maintaining physical health |
- During the past four weeks, has pain stopped you from doing things you want to do?
- Have you had any of the following problems with your work or other regular daily activities because of your physical health?
- Accomplished less than you would like
- Didn’t do work or other activities as carefully as usual
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- Identify ways to improve the pain problem. Determine if your patient could benefit from a consultation with a pain specialist or rheumatologist.
- Consider physical therapy, cardiac or pulmonary rehab when appropriate.
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HOS: Improving or maintaining mental health |
Have you had any of the following problems with your work or other regular daily activities because of emotional problems?
- Accomplished less than you would like
- Didn’t do work or other activities as carefully as usual
- Didn’t have a lot of energy or felt sad or depressed most days
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- Empathize with the patient.
- Consider therapy with a mental health professional when appropriate.
- Offer ideas to improve mental health: Take daily walks, socialize, stay involved with family, own a pet, do crossword puzzles, volunteer, participate in a church, go to senior community centers or meditation.
- Consider a hearing test when appropriate as loss of hearing can be isolating.
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HOS: Monitoring physical activity |
In the past 12 months, did:
- You talk with a doctor or other health care provider about your level of exercise of physical activity?
- A doctor or other health care provider advise you to start, increase or maintain your level of exercise or physical activity?
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- Offer physical activity suggestions based on the patient’s ability.
- Offer ideas for where patients can engage in activities such as senior classes at the Area Agency on Aging YMCA and community centers. These also offer opportunities for social interaction.
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HOS: Improving bladder control |
- In the past six months, have you accidentally leaked urine?
- How much of a problem, if any, was the urine leakage for you?
- Have you received other treatments for your current leakage problem?
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- When talking to patients, note that urinary leakage problems can be common as we grow older, but there are treatments that can help. This opens the conversation if they are too embarrassed to bring it up.
- Do they have leakage problems? Discuss potential treatments options, such as medications, exercises and surgery.
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Please note that the HOS measure for reducing the risk of falling was temporarily removed and will be put back in the 2019 HOS survey. However, it’s still an important topic to discuss with patients.
Ask patients if they experienced a fall. Many won’t report falls to their doctor in fear of losing their independence. Several medications can be responsible for falls, and dosage changes may be all that is needed.
Some things your patients might do to reduce the risk of falling are:
- Using a cane or walker
- Engaging in an exercise or physical therapy program
- Having a vision or hearing test
- Taking vitamin D
** Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternate coding procedures to predict malpractice risk. Medical Care May 2009; 47(5), 1-7. |
