CAHPS: What are they? Why are they important? What do they mean for you?

August 05, 2015


What is CAHPS?

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program is a multi-year initiative of the Agency for Healthcare Research and Quality (AHRQ) to support and promote the assessment of consumers’ experiences with health care.

In addition to the AHRQ, several other Federal agencies contribute to the CAHPS program. The Centers for Medicare & Medicaid Services (CMS) has been a major partner in the CAHPS program since 1996.

Brief History

AHRQ first launched the CAHPS program in October 1995 in response to concerns about the lack of good information about the quality of health plans from the enrollees’ perspective. At that time, numerous public and private organizations collected information on enrollee and patient satisfaction, but the surveys varied from sponsor to sponsor and often changed from year to year. Over time, the program has expanded beyond its original focus on health plans to address a range of health care services and meet the various needs of health care consumers, purchasers, health plans, providers, and policymakers.

The goals of the CAHPS program are two-fold:

  • Develop standardized patient questionnaires that can be used to compare results across providers and over time.
  • Generate tools and resources that providers can use to produce understandable and usable comparative information for both consumers and health care providers.

The effects for clinics will be:

  • Mandated patient satisfaction reporting
  • Reimbursement tied to patient satisfaction
  • Public release of patient satisfaction benchmarks
  • Insurance contracts are influenced by patient satisfaction metrics both regional and national

So why is the CAHPS important?

The patient care experience is broadly recognized as a core element of health care quality. Ever since the Institute of Medicine’s 2001 Crossing the Quality Chasm report codified patient-centeredness as one of six healthcare quality aims, patient-centered care has been at the forefront of healthcare reform. Patients care about the experience of their care, and research has demonstrated that communication and other elements of the care experience are key aspects of the perceived quality of care. The patient care experience has also proved directly related to clinical outcomes, as they are more engaged and adherent to the recommended plan of care. A positive patient experience is also of huge benefit to the organization as a business, such as decreased malpractice risk and staff turnover. Patient experience is increasingly tied to financial incentives. Public and private payers alike have begun to recognize patient experience as a core element of quality, and trends reflect a growing focus on patient experience as an element of compensation structures.

What it means for you

Start collecting patient experience data in the ambulatory setting now and use the information gathered for process improvement to enhance the care experience they are creating. Let’s learn from the hospitals that are already affected by the mandates. Although measuring ambulatory care patient experience is only now gaining momentum, hospitals and health plans already systematically collect patient experience data using the Hospital CAHPS tool, also known as HCAHPS. Hospitals report their data to CMS Hospital Compare, and hospitals’ Medicare payment rates are tied to the results. Within one year, all but a few of the nation’s hospitals had implemented Hospital CAHPS. It is not a stretch to believe that ambulatory settings are the next to be grandfathered into this payment structure.