What is the CAHPS Hospice Survey?

The CAHPS Hospice Survey is an experience of care survey that evaluates the experiences of hospice patients and their caregivers. The survey is sent to hospice patients’ primary informal caregivers (i.e., family members and friends) after the death of the hospice patient. The CAHPS Hospice Survey is used in a CMS pay-for-reporting program which started with the fiscal year (FY) 2017 Annual Payment Update (APU) and continues for subsequent APU periods.

For a more detailed overview, please see the CAHPS Hospice Survey page and review the other resources available to you using the left-side menu.

Who must participate in the CAHPS Hospice Survey?

In general, all Medicare-certified hospices (identified by CMS Certification Number [CCN]) must participate in the CAHPS Hospice Survey in order to receive their full APU. However, certain exemptions are granted by CMS for size or newness.

Exemption for Size:

• If your hospice has served fewer than 50 survey-eligible decedents/caregivers during the “reference period” (decedent date of death) you can apply for an exemption from the CAHPS Hospice Survey
• Exemptions on the basis of size are active for one year only. If your hospice remains eligible for this exemption in subsequent years, your organization will need to request this exemption on an annual basis.

FY – Fiscal year

Exemption for Newness:

• The exemption for newness is based on how recently the hospice received its CCN, also known as the Medicare Provider Number. The criterion for this exemption is that the hospice must have received its CCN on or after the first day of the performance year for the CAHPS Hospice Survey.

For the calendar year (CY) 2018 data collection period, hospices who received their CCN on or after January 1, 2018 are eligible for a one-time exemption for newness. For example, if a hospice receives its CCN any time in 2018 whether it is in January 2018 or December 2018, it is exempt from survey administration for the remainder of 2018. A hospice that receives its CCN any time in 2018 is required to start participating in the CAHPS Hospice Survey beginning with January 2019 decedents.

• This is a one-time exemption for each hospice as identified by CCN.

• Hospices eligible for this exemption will be identified by CMS, as this exemption is based on when the hospice’s CCN is assigned. There is no form for hospices to submit.

How is CAHPS Hospice Survey compliance determined?

The CAHPS Hospice Survey is a pay-for-reporting program, which means that the submission of required data by specified deadlines determines compliance. Data submission requirements include the following:

• Hospices must contract with a CMS-approved survey vendor to collect and submit CAHPS survey data on the hospice’s behalf.

• As of April 2015, hospices are required to participate on a continuous monthly basis.

• Hospices that fail to meet the requirements as specified by CMS will be penalized with a 2% reduction in the APU.

• The participation requirements for CY 2019 will affect the FY 2021 APU. Participation requirements for subsequent years will impact subsequent APUs.

How does a hospice find a CMS-approved CAHPS Hospice Survey vendor?

CMS provides an Approved Vendor List on the official CAHPS Hospice Survey website. Clicking the hyperlink will open the page in a new tab so you can keep your place in the Axxess Help Center.

(After contracting with an approved survey vendor, complete and submit a CAHPS Hospice Survey Vendor Authorization Form. Click the link or use the menu on the left side of the screen to access forms and instructions.)

How can I receive updates/more information related to the CAHPS Hospice Survey?

CAHPS Hospice Survey Website

CMS’ official website for the CAHPS Hospice Survey provides comprehensive information on CAHPS survey requirements for hospice agencies, compliance, and additional information including the following sections:

• Current News
• About the Survey
• Hospice Quality Reporting Program

Hospice Quality Reporting Program (HQRP)

The HQRP website provides provides consumer and provider information regarding the HQRP (mandated by the Affordable Care Act of 2010) and analytic information on CMS’ public reporting of HIS and CAHPS Hospice Survey data.

Hospice professionals can subscribe to the PAC QRP listserv for the latest hospice quality reporting information including training, stakeholder engagement opportunities, and general updates on the following items:

• Reporting Requirements
• Quality Measures
• Reporting Deadlines

How can I contact the CAHPS Hospice Survey Project Team?

• For information and technical assistance: hospicecahpssurvey@HCQIS.org or 1-844-472-4621
• For data submission issues and use of the CAHPS Hospice Survey Data Warehouse: cahpshospicetechsupport@rand.org or 1-703-413-1100 extension 5599
• To communicate with CMS: hospicesurvey@cms.hhs.gov

When is the survey administered?

Data collection for sampled decedents/caregivers must be initiated two months following the month of patient death. The data collection process must be completed within 42 calendar days after initial contact. Submission of the data to the CAHPS Hospice Survey Data Warehouse occurs quarterly. Please see the schedule outlined in the table below.

What was the dry run?

• The national implementation of the CAHPS Hospice Survey began on January 1, 2015 with a dry run conducted in at least one month (January, February or March) of the first quarter of 2015
  • To meet the FY 2017 requirements to qualify for the full APU, hospices were required to contract with an approved survey vendor to conduct a dry run of the survey for at least one month during January, February or March 2015
• During the dry run period, survey vendors were required to comply with all the implementation procedures, including submitting the data to the CAHPS Hospice Survey Data Warehouse. However, the dry run data were not reported to CMS and will not be used for public reporting.
• The dry run provided hospices and survey vendors with the opportunity to conduct a “trial run” of data collection procedures under test circumstances
• The dry run period was allowed for the initial implementation year only; no further dry run periods will be scheduled

What topics are included in the CAHPS Hospice Survey?

Topics include:

• Communication with Family
• Getting Timely Help
• Treating Patient with Respect
• Emotional and Spiritual Support
• Help for Pain and Symptoms
• Training Family to Care for Patient
• Rating of the Hospice
• Willingness to Recommend the Hospice

How many decedents/caregivers will be sampled?

• Hospices with fewer than 50 survey-eligible decedents/caregivers during the prior calendar year are exempt from the CAHPS Hospice Survey data collection and reporting requirements for payment determination, provided the Participation Exemption for Size Form has been submitted by the submission deadline
• Hospices with 50 to 699 survey-eligible decedents/caregivers in the prior calendar year will be required to survey all cases
• Hospices with 700 or more survey-eligible decedents/caregivers in the prior calendar year will be required to survey a minimum sample of 700 cases and may conduct a census

Who pays to administer the CAHPS Hospice Survey?

Participating hospices will contract directly with, and pay, a CMS-approved CAHPS Hospice Survey vendor to administer the survey on behalf of the hospice.

Who will the survey be administered to?

The CAHPS Hospice Survey will be administered to eligible decedents/caregivers from all payer sources.

Who is eligible to be a “primary informal caregiver?”

The CAHPS Hospice Survey is designed to be administered to the person who is most knowledgeable (primary informal caregiver) about the hospice care received by the decedent. The caregiver relationship to the decedent should fall into one of the following categories: spouse/partner, parent (or step parent), child (or step child), other family member, friend, or other. A non-familial legal guardian who does not fall into one of these categories cannot be considered a primary informal caregiver for the purposes of the CAHPS Hospice Survey. The hospice is responsible for identifying the primary informal caregiver that may be eligible to receive and respond to the CAHPS Hospice Survey.

What is meant by the data element “Facility Name?”

A caregiver may associate their family member’s care with the facility where hospice care was received, rather than the actual name of the hospice organization. Therefore, “Facility Name” refers to the name of the facility (e.g., name of the assisted living facility, nursing home, hospital, or hospice house) where care was received. For example, if the decedent received care from Hospice ABC while in Facility XYZ, Facility XYZ is the “Facility Name.”

How do you determine the eligibility of decedents/caregivers?

• Decedents/Caregivers are eligible for the CAHPS Hospice Survey if all of the following criteria are met:
  • To determine if the decedent was age 18 or older at the time of death, use the date of birth and date of death provided by the hospice to calculate the decedent’s age
  • To determine the 48 hour period, one would establish date of admission plus two calendar days. See the below examples for clarification.
    • Example 1: If the patient is admitted to the hospice on January 2 and passes away on January 4; day one is January 3 and day two is January 4. The 48 hours after admission would be met (admission [January 2] plus two days [January 3 and January 4]).
    • Example 2: If the patient is admitted to the hospice on January 2 and passes away on January 3; day one is January 3 and there is no day two. The 48 hours after admission would not be met.
  • A familial legal guardian falls into one of six answer categories provided in the Sample File Layout of Appendix E of the CAHPS Hospice Survey Quality Assurance Guidelines V3.0 (1 = Spouse/partner; 2 = Parent; 3 = Child; 4 = Other family member; 5 = Friend; 7 = Other). The hospice should only indicate the caregiver relationship as 6 = Legal guardian if the caregiver is a non-familial legal guardian.
  • Hospices should not necessarily prioritize a primary informal caregiver who is a family member over a friend, as one caregiver category does not automatically have preference over another. The CAHPS Hospice Survey should be administered to the person most knowledgeable about the care the decedent received at the hospice.
  • Decedents age 18 and over at time of death
  • Decedents with death at least 48 hours following last admission to hospice care
  • Decedents for whom there is a caregiver of record
  • Decedents whose caregiver is someone other than a non-familial legal guardian
  • Decedents for whom the caregiver has a U.S. or U.S. Territory home address

Decedents/Caregivers who initiate or voluntarily request at any time during their stay that the hospice 1) not reveal the patient’s identity and/or 2) not survey him or her will be excluded from the sample frame. Patients whose last admission to hospice resulted in a live discharge will also be excluded.

Note: Decedents/Caregivers must be included in the CAHPS Hospice Survey sample frame unless the survey vendor has definitive evidence that a decedent/caregiver is ineligible. If information is missing on any variable that affects survey eligibility when the sample frame is constructed, the decedent/caregiver must be included in the sample frame. The only exception to this guideline is the date of death; if any part (i.e., day, month or year) of the decedent’s date of death is missing, the case must not be included in the sample frame, and the case must be included in the count of “Missing Date of Death” submitted by the survey vendor to the CAHPS Hospice Survey Data Warehouse.

Note: If a hospice or survey vendor becomes aware that the caregiver is under 18 years old prior to drawing the sample, the caregiver should be excluded from the sample frame.