Home care and hospice organizations have been facing steady rate cuts and higher labor costs, even as patients become more chronically ill and prefer to receive care in their home. This is a reflection of the broader U.S. health system which makes current methods of delivering care and the associated costs unsustainable. According to the Centers for Medicare & Medicaid Services (CMS), in 2012, the U.S. spent 17.2% of the Gross Domestic Product (GDP), also known as the income of the country, on healthcare. This is projected to rise to 19.3% by 2023. This is an unsustainable trajectory, and combined with the safety and quality of care delivered, have been identified as issues at least two decades ago.

A number of preeminent organizations such as the Institute of Medicine have outlined the key issues, with proposed solutions over the years, which influenced the passage of the Affordable Care Act (ACA). The ACA is still being implemented across the country and shaping how healthcare will be delivered in the future. The Institute for Healthcare Improvement (IHI), an independent not-for-profit health organization focused on providing innovative perspective and tools to the wider healthcare community, proposed a new framework for optimizing the performance of health care system. The framework focuses on the simultaneous pursuit of three dimensions, which are collectively called the “Triple Aim”:

• Improving the experience of care.
• Improving the health of populations.
• Reducing per capita costs of health care.

The Triple Aim provides a framework for home health organizations to align their operations to deliver excellent care into the future. A major component of successfully delivering care in the future is the “patient experience of care,” essentially patient centered care and ensuring patients experiences are positive across the total continuum of care. The Consumer Assessment of Healthcare Providers and Systems Home Health Care Survey (HHCAHPS) was designed to measure the experiences of people receiving home health care. The HHCAHPS survey is written as a requirement for Medicare certified home health agencies as THE instrument for measuring patient satisfaction.

As mentioned in a previous blog HHCAHPS 101, the HHCAHPS survey is a 34 item questionnaire (25 core and 9 about you questions) measuring patients’ perceptions of their home care. The questions cover topics such as: communication about care, pain, and prescription medication use, the care received from the home health agency, staying informed about scheduling, and global ratings (“Overall Rating of the Home Health Agency” and “Would You Recommend this Agency to Family and Friends”). The survey was developed in cooperation between CMS and the Agency for Healthcare Research and Quality (AHRQ). The survey is designed to meet the following three broad goals:

• To produce comparable data on the patient’s perspective that allows objective and meaningful comparisons between home health agencies on domains that are important to consumers.
• Public reporting of survey results will create incentives for agencies to improve their quality of care.
• Public reporting will enhance public accountability in health care by increasing the transparency of the quality of care provided in return for public investment.

The CAHPS surveys were launched by CMS in collaboration with the Agency for Healthcare Research and Quality (AHRQ) as part of the government quality care initiative, providing additional transparency to the general public regarding the provision and outcomes of health care. Please look for the next blog in the series which will discuss the role of CAHPS surveys in measuring quality care.