Maryland-based Hospice of the Chesapeake has increased its return rates for Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys through a performance improvement project.

CAHPS surveys are among the most important sources of hospice quality data. 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.

A hospice’s performance on publicly reported quality measures and family satisfaction surveys 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.

Hospice of the Chesapeake within the space of a few months increased their scores from 21.6% to 29%, with further improvement expected as time goes on. A lag time exists between the interventions and the results because families often take as long as four months to respond to the surveys, according to Allie Bolen, QAPI nurse coordinator for Hospice of the Chesapeake.

The process began with the implementation of a new electronic medical records (EMR) system.

“To get our return rate up, the first thing we had to do was assess the current state. Fortunately, with our new EMR, we were able to build out a [key performance indicator (KPI)] dashboard that identified the gaps where we were missing information for the teams to go get them …” Bolen told Hospice News. “We got an improvement team together with a lot of the key stakeholders. We were able to break down the metrics by team to see who had the most opportunity for improvement, who serves the most patients, but maybe necessarily, is not getting the most surveys back.”

The improvement team included staff from admissions and intake, team managers, inpatient center representatives, administrative staff, health information management, compliance and a liaison to the EMR vendor. They examined clinical teams’ current practices and identified areas where they could implement workflow changes, Bolen said.

The organization’s inpatient centers saw the largest gains. CAHPS response rates hovered between 9% and 15% for inpatients prior to the interventions. Following the project, they reached 35%, according to Bolen.

Chesapeake not only improved their rate of responses to the surveys, they also gained more positive feedback.

“When you get more surveys back, you’re more likely to get positive survey results. People are more likely to report favorable things,” Bolen said. “In the world today, it doesn’t matter where you go, everybody wants you to leave a review. If people are more likely to leave a negative review. It doesn’t matter if the CAPHS survey ever hits their door. If they’re unhappy with the care, you’re going to hear about it on Yelp. They’re going to write a letter, you know. So really just increasing that return rate, it’s all favorable changes in our score.”

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. Payers and referral partners increasingly consider these metrics as they select hospices to work with, as do patients and families.

In addition to star ratings, starting in 2025 CAPHS scores will factor into CMS’ algorithm for identifying hospices for its new Special Focus Program (SFP).

Congress mandated the SFP in the Consolidated Appropriations Act of 2021, which contained language from the Helping Our Senior Population in Comfort Environments (HOSPICE) Act. This was in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS).

The program will have the authority to impose enforcement remedies against hospices with poor performance based on its algorithm. Hospices flagged by the SFP also will be surveyed every six months rather than the current three-year cycle and could face monetary penalties or expulsion from the Medicare program. These names of these organizations will also be made public.

For Hospice of the Chesapeake, staff education also played a part. They sought to identify and address knowledge gaps among staff that could influence response rates or scores.

“We really had to do a lot of education, for example, on how to identify the primary caregiver, because it’s not always the power of attorney that should be receiving the survey, or the spouse. It might be the child that’s doing most of the care,” Bolen said. “So it was just really getting teams to intentionally think about that, who should get the survey, the need to ensure they are complete and accurate.”