The Patient Experience of Care Survey uses the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) instrument.

• It collects patient (or their family or friend’s) feedback about topics for which the patient is the best source of information.
• This is the first national standard for collecting information on patient experiences that would enable valid comparisons among all home health agencies.
• HHCAHPS has a core set of questions.
• Agencies can add their own customized questions to the survey to support internal customer service and quality-related activities.

• The purpose of the survey is to gather information from patients (or their family or friends) about their experiences with a home health agency. For example, the survey asks patients about the care they got from their home health agency, and whether they would recommend that agency to someone else.
• When choosing a home health agency, patients can use this information to find out what other patients thought about the care given by a certain home health agency.
• Additionally, public reporting of the survey results is designed to create incentives for home health agencies to improve quality of care. Public reporting also serves to enhance public accountability in health care by increasing transparency.

For more information about the HHCAHPS Survey go to https://homehealthcahps.org.

The survey is composed of 34 items. The core survey items are questions 1 to 25. The remaining questions in the “About You” section are used for analysis. On average, it takes respondents about 12 minutes to complete the HHCAHPS Survey items. The core questions are combined into three measures that consist of multiple survey items (composites) and two global items. The three composites are:

• Care of Patients includes survey questions 9, 16, 19, and 24
• Communication between Providers and Patients includes questions 2, 15, 17, 18, 22, and 23
• Specific Care Issues includes survey questions 3, 4, 5, 10, 11, 12, and 13

The two global ratings are:

• Rating of the Home Health Care on a scale from 0 to 10
• Would You Recommend this Home Health Agency (Definitely Yes, Probably Yes, Probably No or Definitely No)?

The actual wording of the HHCAHPS questions can be found under “Survey and Protocols” on the HHCAHPS website, https://homehealthcahps.org.

The United States Department of Health and Human Services’ (USDHHS) Agency for Healthcare Research and Quality (AHRQ) carried out a rigorous, scientific process to develop and test the HHCAHPS instrument. This process entailed multiple steps, including:

• A public call for measures
• Literature review
• Cognitive interviews
• Consumer testing and focus groups
• Stakeholder input
• A large-scale pilot test
• Obtaining stakeholder input after the final testing stages

The Centers for Medicare & Medicaid Services (CMS) received endorsement of HHCAHPS from the National Quality Forum (NQF), which represents the consensus of many healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations. CMS received approval from the federal Office of Management and Budget for the national implementation of HHCAHPS.

The survey is available in three different survey modes: Mail Only, Telephone Only, and Mail with Telephone follow-up (known as Mixed Mode). A family member or friend may fill out the survey for a patient who is physically or mentally unable to do the survey. Detailed information about mode of survey administration can be found in the survey’s Protocols and Guidelines Manual on https://homehealthcahps.org.

Home health agencies contract with CMS-approved HHCAHPS survey vendors. A list of approved vendors can be found at https://homehealthcahps.org. The approved survey vendors collect the survey data and submit it to CMS on behalf of the home health agency.

Patients from Medicare-certified home health agencies are eligible to receive the survey if they:

• Are current or discharged patients who had at least one home health visit at any time during the sample month
• Are at least 18 years of age at any time of their stay and are believed to be alive
• Have received at least two visits from Home Health Agency personnel during a 2 month look-back period (Note that the 2 month look-back period is defined as the sample month and the month immediately before the sample month.)
• Have not been selected for the monthly sample during any month in the current quarter or during the 5 months prior to the sample month
• Are not currently receiving hospice
• Did not have “maternity” as the primary reason for receiving home health care

For more information go to https://homehealthcahps.org.

The sampling protocol is designed to capture uniform information on home health agency care from the patient’s perspective. HHCAHPS scores are designed to reflect the care received by Medicare and Medicaid patients.

• The basic sampling procedure is to draw a random sample of eligible patients on a monthly basis. Smaller home health agencies should survey all HHCAHPS-eligible patients.
• Data are collected from patients throughout each month of the 12-month reporting period.
• Data are then aggregated, on a quarterly basis, to create a rolling 4-quarter data file for each home health agency.
• The most recent four quarters of data are used for public reporting.
• To ensure comparability, home health agencies may not switch type of sampling, mode of survey administration, or survey vendor within a calendar quarter.

For more information about the HHCAHPS sampling protocol, see the Protocols and Guidelines Manual at https://homehealthcahps.org.

Data submitted to the HHCAHPS data center are cleaned and analyzed by a CMS contractor. This contractor calculates home health agencies HHCAHPS scores and forwards them for public reporting on the Home Health Compare website on http://www.medicare.gov.

The results that are displayed on Home Health Compare on http://www.medicare.gov are the three measures that consist of multiple survey items (composites) and the two global ratings.

• The three composites are Care of Patients, Communication between Providers and Patients, and Specific Care Issues.
• The two global ratings include overall rating of home health care and willingness to recommend the agency.

CMS recognizes that patients’ responses to survey items may be affected by patient characteristics. To ensure that differences in survey results reflect differences in agency quality only, survey results will be adjusted for patient mix.
Only the adjusted results are publicly reported on Home Health Compare and are considered the official results.