Understanding the Psychiatric Inpatient Experience (PIX) Survey for CMS Reporting

A guide to the PIX Survey structure, scoring, CMS reporting requirements, and its role in inpatient psychiatric care

Patient experience is an essential aspect of healthcare delivery and has been demonstrated to correlate with patient outcomes in several contexts. The Psychiatric Inpatient Experience (PIX) Survey was developed in 2021 to reliably assess the experience of patients that undergo inpatient psychiatric care.  

This 23-item questionnaire encompasses four domains of patient experience including healing environment, treatment effectiveness, nursing and team presence, and treatment team relationship. Each question is scored on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) with an option of “does not apply” for each question.

Scoring of this tool can be performed on a domain-basis or a total score. Domain scoring utilizes the average score of all questions within that domain. The total score can be calculated as the average score of all questions completed (excluding those answered “does not apply”) for the entire survey.

CMS Adopts the PIX Survey for Inpatient Psychiatric Facility Quality Reporting (IPFQR)

The Psychiatric Inpatient Experience (PIX) Survey is now a required measure under the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program. Inpatient psychiatric facilities must collect PIX Survey data during calendar year 2026 and submit those data to CMS in 2027 for the FY 2028 payment determination.

The measure applies to eligible patients age 13 or older who are discharged from an inpatient psychiatric facility and are able to complete the survey. CMS’s July 31, 2026, FY 2027 IPF PPS final rule did not delay or modify the PIX requirement..

CMS Reporting Requirements for the PIX Survey: 

• The survey should be offered to eligible patients beginning 24 hours before planned discharge. It may be administered electronically or on paper, but the process must preserve patient anonymity. The survey cannot contain patient identifiers or be connected to the medical record.
• Sampling plans should support submission of at least 300 completed PIX Surveys annually. If a facility cannot obtain 300 completed surveys, it must submit the survey results received from all eligible patient discharges.
• If the survey cannot be completed before discharge, the patient should receive a sealable, stamped envelope addressed to the facility for returning the completed paper survey.
• Calendar year 2026 data will be submitted to CMS in 2027 and will affect the FY 2028 payment determination. Failure to meet IPFQR reporting requirements can result in a two-percentage-point reduction to the facility’s annual payment update.

Strengths of the Psychiatric Inpatient Experience (PIX) Survey

The PIX Survey is one of the first of its kind to measure patient experience within the inpatient psychiatric realm. This survey will soon have wide-spread use with its recent adoption into the IPFQR guidelines, allowing for a more robust analysis of its psychometric properties and utility.

Considerations and Limitations of the PIX Survey

Despite its rapid integration into healthcare policy following its creation, there is relatively little research regarding the psychometric properties of this tool. Additionally, no normative values have been published for this tool. Further work is needed to discern how this tool might differ among various populations and patient cohorts, as well as how responses from this tool might be used in quality improvement initiatives within an institution.

Costs and Licensing for Using the PIX Survey

This tool is readily available online and does not require any licensure, registration or fees for use.

“Because the measure developer has made the PIX survey available in the public domain, there is no certification or license required to administer the PIX survey.”

 – Federal Register / Vol. 88, No. 147 / Wednesday, August 2, 2023 / Rules and Regulations p. 51127 

Conclusion: The Future of Patient Experience Measurement in Psychiatry

The PIX Survey gives inpatient psychiatric facilities a standardized way to capture patients’ perspectives on their care experience. While it shows promise in analyzing and improving patient experience for this cohort, more research is needed for actionable guidance regarding post-collection utilization of this tool.

Sources    |    [[1] Psychiatry & Behavioral Health Patient Experience]    |   [[2]  Development and Validation of the Psychiatric Inpatient Experience (PIX) Survey]    |    [[3] Psychiatric Inpatient Experience (PIX) Survey Administration and Data Collection]    |    [[4] Medicare IPF PPS and IPFQR Updates Proposed Rule]