HHCAHPS (Part 2)

In the first part of this series (HHCAHPS 101), we learned about HHCAHPS and its importance. As we recall, HHCAHPS stands for The Home Health (HH) Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, and is designed to “measure the experiences of people receiving home health care from Medicare-certified home health agencies.”[i] We also discussed the survey as a requirement for all Medicare licensed agencies that serve 60 or more patients over the 12 months between April 1^st and March 30^th of the following year. The HHCAHPS survey was created to help increase incentive for agencies to improve quality of care, accountability and creating comparable data from the patient’s perspective allowing consumers to compare home health agencies. We know participation in the survey helps agencies improve patient outcomes and increases revenue from the enhanced profiling of a top performing home health agency.

Now that we know the purpose of the HHCAPS survey, its importance to home health agencies and the public at large, selecting an HHCAHPS vendor is a major decision for home health agencies and positioning them for success. With so many HHCAHPS vendor out there, it is easy for home health agencies to be overwhelmed with making such a decision. Below are 3 criteria that indicate a vendor’s adeptness in the administration of the HHCAHPS Survey:

1. CMS Approved: One of the most important criteria to consider when selecting a vendor for the HHCAHPS survey is whether or not the vendor is CMS approved. This might seem pretty mundane, however, selecting a CMS approved vendor is the difference between a home health agency being successful or not. CMS ensures that all approved vendors are competent enough to carry out the survey, and as such put all approved HHCAHPS vendor through a stringent application and review process before being approved. CMS is responsible for ensuring that the HHCAHPS Survey is “administered using standardized survey protocols and data collection and processing methods.”[ii] CMS in conjunction with its HHCAHPS Survey Coordination Team “provide training, technical assistance, and oversight to approved survey vendors.”[iii] Approved vendors will have shown competency and excellence in all facets of the below categories:
   1. Relevant Survey Experience
   2. Organizational Survey Capacity
   3. Quality Control Procedures

In addition to the meeting all of the requirements of the above categories, approved CMS vendors must complete and submit an acceptable Quality Assurance Plan (QAP). The QAP describes the vendor’s implementation of and compliance with all guidelines required to implement the HHCAHPS Survey. The vendor’s QAP covers the below topics

a)    Organizational Background and Staff Experience

b)   Work Plan

c)    Sampling Plan

d)   Survey Implementation Plan

e)    Data Security, Confidentiality, and Privacy Plan

f)     Questionnaire and Materials attachment

It is extremely important that home health agencies select CMS approved vendors, failure to do so can result in receiving a deficiency status from CMS. A list of approved HHCAHPS Survey vendors can be found here.

1. Quality Control Procedures: A successful HHCAHPS vendor will have the “personnel training and quality control mechanisms employed to collect valid, reliable survey data and achieve, on average, a 32 percent response rate.”[iv] CMS desires agencies to aim for 32% response rate on HHCAHPS survey. Given this, it is important that vendors have a high response rate. An average minimum of a response rate greater than 32% will be a good benchmark for selecting vendors. Vendors with survey experience generally would be able to yield results greater than 32%. Successful HHCAHPS vendors will have established systems for conducting and documenting quality control activities including
   1. In- house training for staff involved in survey operations
   2. Printing, mailing and recording receipt of survey information, if mail survey being conducted, or the use of a Computer Assisted Telephone Interviewing (CATI) system
   3. Coding, editing/keying in survey data
   4. Preparing final patient-level data files for submission.

Vendors also need to be equipped with the functionality and technology that maintains HIPPA compliance when agencies are uploading the patient data to be surveyed.

1. Organizational Survey Capacity: An approved survey vendor needs to have the “capability and capacity to handle a required volume of mail questionnaires and/or conduct standardized telephone and/or Interactive voice response (IVR) interviewing in specified time frame”[v]. It is imperative that the vendor is equipped with the designated HHCAHPS personnel to handle the survey, as well as an onsite call center. Having an onsite call center is especially important, as this ensures HIPPA and CMS protocols are followed. Having an onsite call center means the surveyors are being monitored by the vendor’s management team and the calls are checked frequently for quality. Also, maintaining an on-site call center helps the vendor maintain a call center staff that is trained specifically in CAHPS^® administration. An excellent survey vendor will have the capabilities of conducting the surveys via mail administration, telephone administration and mixed mode administration. This gives patients the flexibility to participate in the survey in the means that is easiest for them. An important factor to consider is experience with transmitting data via HIPPA secure/compliant methods. Patient data is extremely sensitive, and as such HHCAHPS vendors are required by CMS to have a minimum of 2 years experience with transmitting such data.

While this list is not completely exhaustive, it is a guide to helping home health agencies select the best HHCAHPS vendor. Ideally, home health agencies looking to improve patient outcomes, grow revenue and identify areas for improvement will select a HHCAHPS vendor that meets and exceeds all of the above points.

[ii] https://homehealthcahps.org/portals/0/pandgmanual_noapps.pdf

[iii] https://homehealthcahps.org/portals/0/pandgmanual_noapps.pdf

[iv] http://www.hcahpsonline.org/files/HCAHPS_Minimum_Business_Requirements_V9_0.pdf

[v] http://www.hcahpsonline.org/Files/MinimumRequirements2013.pdf