Hospice CAHPS Scores Key Differentiator in Competitive Market

Quality is closely tied to financial sustainability in an increasingly competitive hospice marketplace. A hospice’s performance on publicly reported quality and family satisfaction measures is a key differentiator that could attract or deter interest from the gamut of investors, referral partners, payers and consumers. Falling short in quality can determine whether a hospice sinks or swims against the tide of competition.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey ratings is among the most important sources of hospice quality. The U.S. Centers for Medicare & Medicaid Services (CMS) requires that hospices send the survey to families following a patient’s death to gauge their satisfaction with the services they’ve received.

Hospices should pay close attention to how their CAHPS ratings compare not only with competing providers, but also against nationwide averages, according to Liz Silva, director of home health and hospice at HEALTHCAREfirst.

“Understand how you compare with both the state and national scores [and] how, without that external comparison, you may not know how you are performing,” Silva told Hospice News during a recent webinar. “That’s a critical piece — to understand how you do compared to others — since that’s how the star ratings are going to be calculated. It takes into consideration all providers’ scores to wrap together, so it’s really important to be able to understand how your current scores are compared with the rest of the industry.”

CMS uses publicly reported quality data, including CAHPS scores, to calculate star ratings found on the agency’s Care Compare website. Patients and other stakeholders can view quality and patient satisfaction scores, cost information as well as data on the providers’ service volume, among other metrics. Star ratings for hospice providers are expected to begin appearing on Care Compare in August 2022. These metrics will play a part in the consideration for payers and referral partners as they select hospices to work with. CMS plans to update publicly reported CAHPS scores quarterly, and the star ratings themselves, every other quarter. 

Performance data will also be a priority for investors in the space. The hospice market has been heating up in recent years as demand for end-of-life and serious illness care rises. A little more than 1.61 million Medicare descendants were enrolled in hospice during 2019, a 3.9% increase from 2018, according to the National Hospice and Palliative Care Organization (NHPCO). Hospice utilization rose to a new record of 51.6% nationwide in 2019, up from 50.6% the previous year, according to the Medicare Payment Advisory Commission (MEDPAC).

Growing demand has spurred investor interest in the hospice market, which has been riding high throughout the last several years running. Valuations in the hospice space have hit record-highs, with multiples in some deals reaching 26.2x compared to 16.1x for the overall health care sector, according to a report from PricewaterhouseCoopers (PwC). Of the hospice acquisitions that took place during a 12-month period ending May 15, 2021, these deals collectively exceeded $11.8 billion.

Poor performance on quality measures can pose risks to a hospice’s bottom line and could indicate that patients and families are not receiving appropriate care.

Working systematicly to improve CAHPS scores can give hospices a competitive advantage. The surveys and other consumer feedback can help providers determine whether their services are consistent with patients’ and families’ expectations and priorities. For example, one element that can impact ratings is effective communication with the family in a timely fashion. Last year, roughly 80% of family caregiver respondents to a survey from Citus Health indicated that timely communication was among the important quality factors driving their decisions toward or away from a hospice.

Both internal and external benchmarking is essential to ensure high quality. Providers should not only compare against their competitors, but also their own performance over time when seeking out strategies to boast CAHPS scores., according to Silva.

“Accessing and taking advantage of the report suites that your survey vendor may have available will be really important for you to incorporate,” said Silva. “Making changes is when you’re tracking your own performance improvement efforts [and] the data that are going to be reported publicly. There’s a lot of data available, and whittling it down into the most meaningful pieces that are going to drive your improvement is a critical piece. What your vendor provides, it’s being able to drill through into the patient-level or caregiver-level details [that] can be extremely helpful as you’re trying to tie the results back to operations.”

After collecting their data, hospices must analyze what they learn to understand how the numbers reflect what is happening operationally, including being able to pinpoint where breakdowns may have occurred, according to Silva.

“Reflecting what’s happening at the moment in data with surveys is through having access to your results as they come in and [seeing] at that time what sort of operational issues there were. If there were issues with communication near or around the time of the patient’s death, or you can identify where there were staffing issues, and really drill down into the data to understand what might be driving the caregivers’ perception of care around that time.”