6 tips to improve your CAHPS Hospice Survey scores

By: Liz Silva, Product Manager, Home Health and Hospice, HEALTHCAREfirst, and Pam Saucier, RN, BSN, MBA, Home health and Hospice Consultant, Guardrails, LLC

The CAHPS hospice survey mandated by CMS is vital to your agency’s success. The survey determines your Star rating, which is publicly posted on Medicare’s Care Compare website so that families and referral sources looking for hospice care can make an informed choice. To keep your agency competitive, it’s important to have a clear understanding of the do’s and don’ts of the survey process, as well as some tips for improving your agency’s scores.

CAHPS survey regulations
CMS has clear rules for what agencies can and cannot say to their clients about the CAHPS survey. Some of the information about the survey you can share include:

• The survey’s purpose and that it’s a government survey
• It’s administered by a third-party vendor, not the hospice agency
• That the survey will be sent about two months after the patient’s death
• That the survey should reflect the client’s perspective on hospice care provided
• That not all clients will receive a survey
• Survey questions should be completed in full

But when discussing the CAHPS survey with a client, you cannot:

• Influence a family’s decision on whether to complete the survey
• Share the survey ahead of time with patients or families
• Influence how survey questions are answered
• Contact or question the family about their responses
• Use wording included in survey questions in discussions with families

What does the survey measure?

Survey questions fall into six main sections. Communication with the family is the first section, including questions about whether visit times were clearly communicated; whether explanations were easily understood by the family; whether patient and caregiver concerns were listened to; whether information was provided on the patient’s condition; and whether the hospice team shared any confusing or contradictory information.

The survey also covers timely help: families are asked if help from your hospice agency was available when needed, including evenings, weekends and holidays. Then there are questions about whether the patient was treated with respect and dignity, and whether the family felt the hospice team cared about the patient. Questions about emotional and spiritual support gather feedback about whether the family’s religious and spiritual beliefs were respected and supported during what is inevitably a difficult time.

Two more topics in the survey cover pain and symptom management and family training to care for the patient. For pain and symptom management, families are asked not only whether the patient’s pain was adequately managed, but also whether there was help with symptoms including respiratory distress, constipation, anxiety or sadness. Families are asked whether they had adequate information and training on when to give pain medication to the patient, about how to manage any side effects the patient experienced and managing any agitation or restlessness the patient experienced.

Steps you can take to improve your scores

Because your CAHPS score is so important to the health of your business, it pays to think about steps you can take to improve not only your scores, but also the care you provide day in and day out. This short list offers some ideas for getting started.

1. Increase the number of responses from your agency’s clients. We all receive so many surveys from retailers or health providers and everything in between, and no one fills out all of them. Encourage your clients to fill out the CAHPS survey and provide their feedback—positive or negative—so you can identify areas for improvement or recognize team members who do a great job.

2. Make sure your staff is familiar with the survey. Starting with orientation of new staff, focus on the survey. Share a copy and remind your team that the survey focuses on family’s perspective, not your agency’s. Share the CMS rules about how they can and cannot communicate about the survey and emphasize the importance of clear communication with patients and families. Remember that all of the families you’re working with are in a period of crisis and may be feeling overwhelmed with grief, so extra attention to frequent, repetitive communication is vital.

3. Share CAHPS survey results with all team members. All team members, not just your clinical or leadership staff, should see survey results. Sharing results with your interdisciplinary teams is a good idea as well, since these are the people who cared for your patients and whose work the survey reflects. Reassure everyone that there are no perfect survey results, so there will always be areas to improve. The results will help you develop a well-defined corrective action plan that can be a constant focus, not something that only gets attention when survey results come back.

4. Trend your survey results. Most CAHPS survey vendors allow you to trend your results by team and by individual. This lets you know if you have a widespread issue, or if a specific team or patient care manager needs more support or training. This isn’t meant as a way to get individuals in trouble; it’s an opportunity for improvement. Riding along with an employee on visits is one way to offer additional training and communication that can really help.

5. Evaluate your patient and caregiver handbook. Most agencies have some kind of folder or notebook that gives families information about hospice care in general, your hospice, and what each member of your team does. Be sure you also have clear information about what they can expect from the hospice team, and that contact information is clear and easy to find. The handbook should include information about the CAHPS survey, basic pain medication information, and symptom control. Being proactive and giving families important information in writing can clarify expectations and help avoid misunderstandings that can lead to complaints from the family.

6. Celebrate your successes. When you get positive comments and good survey results, be sure to recognize the individuals or teams in some way. Whether it’s a handwritten note or simply complimenting an employee who receives positive comments, your staff will appreciate the recognition. Another idea that can keep your staff focused and engaged is setting up team competitions to see who gets the best survey results.

Plan to be in it for the long haul

Improving your Star rating is a long-term project. Don’t expect to put new practices in place one month and see improvements in your online ratings the next month. Achieving your goals will take constant and frequent attention from your entire staff. Monitor results from your survey vendor, and help your staff keep in mind all the factors that go into those results—not only for the sake of your scores, but also to provide the care and dignity your patients and their families deserve.

See the difference HEALTHCAREfirst can make

For more than 25 years, HEALTHCAREfirst has been the premiere provider of RCM services, CAHPS surveys and advanced analytics for home health and hospice organizations. Trust us to help you accelerate reimbursement, maximize cash flow, reduce risk of denials, and go beyond compliance.

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