What is the Hospice CAHPS Survey?

Drawing heavily on questionnaires from the public domain such as the Family Evaluation of Hospice Care (FEHC), CMS implemented a CAHPS® Hospice Survey, also referred to as Hospice CAHPS, to measure the experiences that patients and their caregivers have with hospice care. The survey was developed to:

  • Provide a source of information from which selected measures could be publicly reported to beneficiaries and their family members as a decision aid for selection of a hospice program
  • Aid hospices with their internal quality improvement efforts and external benchmarking with other facilities
  • Provide CMS with information for monitoring the care provided

Who will receive the survey?

The survey is administered post-death to the patient’s informal caregiver, which is the person listed in the hospice record as the primary caregiver or primary contact for the patient. All decedents/caregivers are eligible for inclusion in the survey sample except:

  • Primary caregivers of patients under the age of 18 at the time of death
  • Primary caregivers of patients who died within 48 hours of admission to hospice care
  • Patients for whom no caregiver is listed or available, or for whom the caregiver contact information is not known
  • Primary caregivers who are legal guardians that are unlikely to be familiar with care experiences
  • Primary caregivers with a foreign (non-US or US territory address) home address
  • Patients or caregivers who requested that they not be contacted

Do I have to contract with a vendor for Hospice CAHPS?

Yes. All eligible hospices are required to contract with a CMS-approved, third-party vendor for administration of the Hospice CAHPS survey. The third-party vendor is responsible for determining survey eligibility, administering the survey, and reporting results to the CAHPS Hospice Survey Data Warehouse on behalf of the hospice.

Is HEALTHCAREfirst a CMS-approved vendor for Hospice CAHPS?

Yes! In 2015, HEALTHCAREfirst acquired Deyta, a CMS-approved vendor for Hospice CAHPS since implementation in 2015.

Deyta’s experience with the FEHC survey and unique approach has allowed hospices to effectively manage QAPI programs and initiatives for years. Prior to the acquisition, Deyta successfully transitioned all existing FEHC clients over to Hospice CAHPS and onboarded many new clients. Together, we continue to maintain our strong reputation as the leader in CAHPS administration and for partnering with our clients to leverage data for quality and performance improvement.

How do I authorize HEALTHCAREfirst as my Hospice CAHPS survey vendor?

To authorize HEALTHCAREfirst as your Hospice CAHPS vendor, hospices must complete the Hospice CAHPS Survey Vendor Authorization Form, have it notarized, and mail it to the address provided on the form. Contact us to learn more about authorizing HEALTHCAREfirst as your vendor or to request a copy of this form with our information populated for you.

Is my hospice exempt from participation?

All Medicare-certified hospices serving 50 or more decedents/caregivers during a reference year are required to contract with a CMS-approved vendor for survey administration, and must provide a data file to the approved vendor on a monthly basis.

Hospices with fewer than 50 decedents/caregivers during a reference year can choose to fully participate in the Hospice CAHPS program or may request exemption for size. Hospices that choose to request exemption must submit a request for exemption each year by submitting the exemption form at http://www.hospicecahpssurvey.org/.

Hospices that are new and receive their Medicare Provider Number (CCN) on or after January 1st are exempt due to newness for that calendar year. CMS automatically identifies these hospices as eligible for exemption and no form is required.

What happens if my hospice fails to comply?

Eligible hospices are required to participate in the survey or risk a 2% reduction to their Annual Payment Update (APU). For more information regarding this topic and associated timeframes, please contact us.

Survey Design

Which topics are covered on the survey?

The survey was developed according to the principles used in the development of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys and includes 47 core questions. Covered topics include:

  • Hospice Team Communication
  • Getting Timely Care
  • Treating Family Member with Respect
  • Getting Emotional and Religious Support
  • Getting Help for Symptoms
  • Getting Hospice Care Training
  • Overall Rating of Patient Care
  • Willingness to Recommend

Will a cover letter accompany the Hospice CAHPS survey?

Yes. In accordance with the protocols and guidelines set forth by CMS, caregivers will receive a standardized Hospice CAHPS cover letter with the survey. For caregivers that do not return the survey within 21 days of the initial mailing, a second survey and cover letter with a reminder note will be mailed.

Can I customize the cover letter(s) and survey to include my hospice’s logo?

Yes. In fact, this is standard practice for HEALTHCAREfirst. Identification with the care provider has been proven to positively impact survey response rates. Therefore, we include your hospice’s logo on the survey tool. Cover letters also include your hospice’s logo, as well as a digital signature from a representative of the hospice.

Does HEALTHCAREfirst’s Hospice CAHPS survey tool offer caregivers an opportunity to hand-write comments?

Yes. Respondent comments are extremely valuable because they provide context around the quantitative data captured by CAHPS surveys. Our Hospice CAHPS service includes full transcription of caregiver comments, detailed reporting that groups comments by topic and type, and notification by email of negative or serious comments.

Does HEALTHCAREfirst offer a supplemental question set for Hospice CAHPS?

Yes. To provide hospices with the opportunity to utilize valuable data for enhanced performance improvement, we include a supplemental question set as part of our standard Hospice CAHPS survey administration service.

Does HEALTHCAREfirst offer a Veterans-specific supplemental question set for Hospice CAHPS?

Yes. For hospices that wish to capture data specific to United States Veterans, we offer a Veterans supplemental question set.

Are the survey and supplemental question sets offered in languages other than English?

Yes. We offer the Hospice CAHPS survey and standard supplemental question set in Spanish.

Survey Administration

What are the surveying requirements?

Hospices must contract with an approved third-party vendor for survey administration. The third-party vendor is responsible for reporting data to the Hospice CAHPS Data Warehouse on behalf of the hospice.

  • Beginning April 1, 2015, eligible hospices are required to participate continuously, on a monthly basis
  • Hospices serving 50 to 699 decedents/caregivers during a reference year are required to survey all survey-eligible caregivers
  • Hospices serving 700 or more decedents/caregivers during a reference year are required to survey a sample size of at least 700 survey-eligible caregivers

When does my hospice need to start administering the Hospice CAHPS survey?

Hospices serving 50 or more decedents during a reference year (January 1 – December 31) must participate in Hospice CAHPS surveying the following year. For example, if your hospice serves 50 or more decedents from January 1, 2016 – December 31, 2016, you are required to participate starting with January 2017 patients.

When will the caregiver receive the survey?

To allow the caregiver some recovery time, CMS requires that the survey be mailed two months following the month of death. For example, caregivers of January decedents will receive the survey in April. If the caregiver does not return the survey within 21 days of the initial mailing, they will be sent a second survey with a reminder cover letter.

What is the data collection period?

CMS has established a 42-day data collection period that begins when the initial survey is mailed to the caregiver.

What happens if a caregiver returns the survey after the 42-day data collection period?

Surveys returned after the 42-day data collection period are not reported to CMS, however we will still process these surveys. Our reports provide an option for hospices to generate reports including only the surveys CMS will use for reporting or to include all surveys returned, including those returned after the data collection period.

Is my hospice’s data submitted to NHPCO like it was with the FEHC survey?

No. Hospice CAHPS data is only submitted to CMS.

Are results from the supplemental question sets reported to CMS?

No. Results from supplemental question sets are captured and reported to the hospice only with the intent of providing greater insight into the perception of care. Results are not reported to CMS.

When is data reported to CMS?

HEALTHCAREfirst reports Hospice CAHPS data to CMS via the CAHPS Hospice Survey Data Warehouse on a quarterly basis:

Collection Period Deadline for submission to Data Warehouse
Q1 2017 August 2017
Q2 2017 November 2017
Q3 2017 February 2018
Q4 2017  May 2018

Will my hospice’s data be submitted to CMS for public reporting?

CMS is targeting to report hospice data publicly beginning in August 2017 through the Hospice Compare website. While we don’t know exactly what public reporting for hospice quality data will look like, the Hospice CAHPS survey has been endorsed by NQF and CMS has outlined 8 Hospice CAHPS Quality Measures. View Hospice CAHPS Quality Measures to see the 8 quality measures and corresponding questions from the Hospice CAHPS survey.

Can my hospice continue using the Family Evaluation of Hospice Care (FEHC)?

No. Once a hospice begins using the Hospice CAHPS survey, it may not use the FEHC survey at the same time, for the same population.

Can my hospice continue administering the Family Evaluation of Bereavement Services (FEBS)?

Yes. Although CMS requires the Hospice CAHPS survey to be the first survey a caregiver receives, the FEBS can still be administered since it is not mailed until several months after the Hospice CAHPS survey.

Can my hospice include a copy of the Hospice CAHPS survey in our admission packets like we do with FEHC?

No. CMS has specified in the Quality Assurance Guidelines that hospices cannot show or provide a copy of the survey or cover letters to the patient or caregiver before the survey is administered. Hospices may generally inform all caregivers that they may receive a survey from HEALTHCAREfirst, but should refrain from any communication that could influence a caregiver to respond in certain way.

What if a patient or caregiver does not want to receive the survey?

A hospice can identify a record as “no publicity” and exclude the patient/caregiver from the list of records sent for survey administration only if the patient or caregiver voluntarily requests to be removed from communications or be excluded from participating in the survey. Hospices may not use this as an “opt out” option to exclude certain patient/caregivers from survey administration.

Does HEALTHCAREfirst work with my Electronic Health Records (EHR) vendor?

HEALTHCAREfirst worked with many EHR vendors to create a standardized export of the necessary data elements for Hospice CAHPS survey administration and created many interfaces to automate the transfer of data. These relationships have continued and we have added new EHR vendors to our list. Contact us to learn more about our work with your EHR vendor.