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Improving Home Health CAHPS Results: Agency Responsiveness

The Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) patient engagement survey impacts the bottom line of home health agencies substantially, by attracting referral sources and value-based reimbursement. It is imperative for organizations to understand the HHCAHPS survey, and work on improving each measure to maximize long-term growth and sustainability.

Agency Responsiveness – Question 23

Question 23 is the last of six questions included in the Home Health CAHPS survey Communications domain, designed to assess how effectively healthcare providers communicate with patients about their treatment plans.

Communications Between Providers and Patients

This question seeks to evaluate the patient’s perception of how promptly the agency office responded to requests for help or advice.

Suggestions for Improving Communications

  • Ensure patient requests are prioritized and forwarded to appropriate staff members as needed.
  • Set agency objectives for addressing patient requests with proficiency and timeliness, aiming to routinely address patient requests within the same day they are received.
  • Provide staff coaching on timeliness best practices, and agency expectations throughout the organization.

The Home Health CAHPS survey scoring for this question is based on the percentage of respondents who select the Same day response option. Optimizing performance on this question relies, therefore, on an agency’s ability to ensure patient requests are consistently addressed the same day they are received. The model scenario below demonstrates the calculation used for scoring Question 23 for public reporting by CMS.


  • An agency received a total of 10 responses to Question 23.
  • 6 patients responded Same day;
  • 2 patients responded 1 to 5 days;
  • 1 patient responded 6 to 14 days; and
  • 1 patient responded More than 14 days.
  • The agency scored 60% for this question (Same day responses/10 total responses= 60%).

When establishing organizational expectations for addressing patient requests, best practices include incorporating metrics for tracking permissible lag times between initial receipt of the patient’s request and staff responses, to final resolution. Agency guidelines, for example, might require patient requests received from 8 a.m. to 11 a.m. to be addressed by the close of business hours the day they are received. Requests received 12 p.m. or later might require resolution by 12 p.m. the following business day, or close of the following business day. When introducing or adjusting organizational standards, metrics deliver a level of clarity needed to facilitate and guide discussion on institutional expectations.

Although healthcare professionals and organizations generally acknowledge the need for punctuality in addressing patient requests, many institutions still underestimate the importance of continuously refining best practices for optimizing service timeliness. Staff training and ongoing staff engagement efforts are particularly relevant when aiming to enhance areas where individual employee performance directly impacts the patient experience, such that overall agency performance is influenced substantially (e.g., office timeliness). Engaging staff is a powerful determinant for which agencies are considered superior in the healthcare industry, and which agencies elect only to provide passable service and produce substandard performance.

Organizations that coach staff to respond to patient requests with broad, ambiguous guidance (e.g., ‘respond to patient requests in a timely manner’) are at a severe disadvantage when compared to agencies that implement systematic, specific instruction in training (e.g., ‘respond to patient requests within four hours,’ or ‘respond to patient requests by 5 p.m. the following business day,’ etc.). Specific time intervals, as outlined in the latter instance, are quantifiable and preclude subjectivity, so the opportunity for staff members to interpret meanings behind expectations is eliminated. Metrics equally afford agency leadership the opportunity to measure performance and employee protocol adherence, ultimately allowing for longitudinal performance tracking and solidifying ongoing improvement efforts.

Since the nature of patient requests, and time for appropriately addressing them, can vary substantially from one request to another, discuss institutional objectives collaboratively prior to implementation. Ultimately convene with agency leadership and staff members to best identify expectations that are practical for the organization to uphold, and relevant to the patient’s experience.

Check our blogs for the series on improving your agency’s HHCAHPS scores by systematically reviewing each of the HHCAHPS questions and sharing opportunities for improvement.



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