What is HCAHPS?
A guide for hospitals & healthcare teams

Imagine this: A patient sits in a hospital waiting room for hours.

The facility is lacking in cleanliness, the front desk staff doesn’t make eye contact, and communication is lacking when the patient meets the doctor or nurse.

Finally, they leave the hospital with unclear discharge instructions. Ultimately, feeling unheard and unseen.

Patients want to build a trusting relationship with their doctor.

How well patients feel they were treated and cared for during their hospital visit impacts their satisfaction.

Measuring and improving patient satisfaction has never been more critical in healthcare.

But how do you really measure patient satisfaction?

Enter HCAHPS.

HCAHPS is a standardized tool that helps hospitals gather in-depth insights into patients’ experiences.

HCAHPS is an opportunity for hospitals to demonstrate quality of care, earn patient trust, and refine operations.

In this guide, I will explain everything you need to know about HCAHPS, from what it is and how it works to how scores can benefit hospitals and patients.

I’ll also provide helpful tips for improving HCAHPS scores to create a more human and impactful experience for you and your patient.

Discover how NRC Health can help elevate your HCAHPS strategy. Contact us today!

HCAHPS stands for the Hospital Consumer Assessment of Healthcare Providers and Systems.

HCAHPS is the first national, standardized, and publicly reported survey collecting patient feedback on hospital care experiences.

HCAHPS is conducted across hospitals that accept Medicare funding and provides comparability between facilities to encourage higher standards of patient care.

It was developed by the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ).

HCAHPS serves three primary goals:

1. Transparency for public accountability
2. Consistency in measuring patient experiences across hospitals
3. Improved quality of care through patient feedback

Susan Edgman-Levitan, PA, explains HCAHPS, “HCAHPS is correlated with important clinical outcome measures. For example, hospitals that do well on the ‘responsiveness of staff’ measure have fewer falls and other safety events. Higher scores on the ‘doctor and nurse communication’ composites are linked to lower malpractice claims. If we remove the barriers our clinicians and staff face in providing care, they can focus on their patients and improve outcomes in the process.”

Top-box scores represent the percentage of patients who selected the most positive response option.

Examples:

• “Always” (for frequency-based questions)
• “9” or “10” (for the overall hospital rating question)
• “Definitely yes” (for the recommendation question)

For example:
If 72% of patients answered “Always” when asked whether nurses treated them with courtesy and respect, the hospital’s top-box score for that measure is 72%.

Top-box scoring is the most commonly cited HCAHPS performance metric and is heavily used in public reporting and benchmarking.

HCAHPS uses specific response scales:

• Always / Usually / Sometimes / Never
• 0–10 rating scale for overall hospital rating
• Definitely yes / Probably yes / Probably no / Definitely no

CMS defines “Always,” “9,” “10,” and “Definitely yes” as top-box responses.

These responses indicate the highest level of patient satisfaction and are used in star rating calculations.

CMS also reports linear mean scores.

Linear mean scoring converts survey responses into a 0–100 scale, allowing hospitals to compare performance more precisely across domains.
For example:

• • “Never” may convert to 0
  • “Sometimes” to 33
  • “Usually” to 67
  • “Always” to 100

  The linear mean score represents the average across all responses.

  This scoring method helps analysts detect smaller performance shifts that may not appear in top-box reporting.

CMS publicly reports HCAHPS results as part of the Hospital Consumer Assessment Summary Star Rating on Medicare’s Care Compare website.

The summary star rating:

• Uses 1 to 5 stars
• Is calculated using a statistical clustering methodology
• Groups hospitals into performance categories based on relative performance across 10 publicly reported measures

CMS applies a clustering algorithm to determine star thresholds. This approach creates performance groupings that shift as national performance changes.

The HCAHPS Survey collects responses from patients about essential elements of their hospital experience. The survey is given after their hospital stay.

The HCAHPS Survey allows hospitals to compare patient satisfaction on a national scale. CMS ties HCAHPS results directly to Medicare reimbursement.

The HCAHPS Survey aims to give care providers a peek into gaps they may not have seen before and transform the patient experience for better, long-term relationships.

The HCAHPS Survey includes 32 questions starting in 2025 (previously 29) covering key patient care areas in their recent hospital stay.

The survey is broken down into 11 dimensions dedicated to the patient’s hospital experience, including:

• Communication with nurses
• Communication with doctors
• Care Coordination
• Restfulness of the hospital environment
• Responsiveness of hospital staff
• Communication about medicines
• Discharge information
• Cleanliness of the hospital environment
• Information about symptoms
• Hospital rating
• Recommend the hospital

The dimensions above include questions related to the patient’s experiences.

Here are some examples of the HCAHPS Survey questions:

Communication with nurses

• During this hospital stay, how often did nurses treat you with courtesy and respect?
• During this hospital stay, how often did nurses listen carefully to you?
• During this hospital stay, how often did nurses explain things in a way you could understand?

Communication with doctors

• During this hospital stay, how often did doctors treat you with courtesy and respect?
• During this hospital stay, how often did doctors listen carefully to you?
• During this hospital stay, how often did doctors explain things in a way you could understand?

Care coordination

• During this hospital stay, how often were doctors, nurses, and other hospital staff informed and up-to-date about your care?
• During this hospital stay, how often did doctors, nurses, and other hospital staff work well together to care for you?
• Did doctors, nurses, or other hospital staff work with you and your family or caregiver in making plans for your care after you left the hospital?

Restfulness of hospital environment

• During this hospital stay, how often were you able to get the rest you needed?
• During this hospital stay, how often was the area around your room quiet at night?
• During this hospital stay, did doctors, nurses, and other hospital staff help you to rest and recover?

Responsiveness of hospital staff

• How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?
• During this hospital stay, when you asked for help right away, how often did you get help as soon as you needed?

Communication About Medicines

• Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
• Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

Discharge information

• During this hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed after you left the hospital?
• During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?

Cleanliness of hospital environment

• During this hospital stay, how often were your room and bathroom kept clean?

Information about symptoms

• Did doctors, nurses, or other hospital staff give your family or caregiver enough information about what symptoms or health problems to watch for after you left the hospital?

Hospital rating

• Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

Recommend the hospital

• Would you recommend this hospital to your friends and family?

Hospitals gain insights into what matters most to patients by asking these questions.

The HCAHPS Survey is given between 48 hours and six weeks after the patient is discharged from the hospital. Returned surveys are accepted up to 49 days after the initial survey is sent.

Hospitals administer HCAHPS Surveys through multiple methods, including:

1. Mail-only
2. Telephone-only
3. Mail and telephone
4. Web and mail
5. Web and telephone
6. Web, mail, and telephone

Hospitals are required to administer the HCAHPS Survey with the exception of Critical Access and Rural Emergency hospitals, who may participate voluntarily.

Hospitals can partner with an approved survey vendor like NRC Health for HCAHPS data collection and submission to CMS for scoring and reporting.

It’s important to remember that data from the HCAHPS Surveys are publicly reported.

The CMS publishes HCAHPS data on the Care Compare website and in the Provider Data Catalog four times a year.

By publicly reporting HCAHPS scores, hospitals are held accountable for the quality of care. It also empowers patients to choose care providers based on other patients’ experiences.

HCAHPS scores are a direct reflection of the patient’s hospital experience.

HCAHPS scores aggregate patient feedback into publicly reported results on CMS’s Care Compare website.

High scores showcase better quality care, improve patient satisfaction, and boost the hospital’s reputation.

HCAHPS scores give patients the power back, allowing them to make more informed healthcare decisions and giving hospitals the chance to prioritize the human side of healthcare.

Jon Roberts, MD, Pulmonology, Cystic Fibrosis Center, Driscoll Children’s Hospital, describes the impact of human connection on healthcare.

“Despite the extensive training we undergo—medical school, residency, and fellowship—it’s the ability to connect with patients and families on a personal, human level that brings unparalleled satisfaction to this job.”

HCAHPS scores are summarized on a 5-star rating scale, where five stars indicate the highest level of patient satisfaction.

Hospitals achieving 4- or 5-star ratings are leaders in patient care quality. With the average HCAHPS summary score topping 3.3 out of 5, there is room for improvement.

For example, states like Minnesota and Wisconsin consistently average 4-star ratings, setting benchmarks for patient satisfaction.

Consistently high scores indicate a hospital’s commitment to delivering exceptional patient care.

At NRC Health, we drew a random sample of 100,000 comments from HCAHPS respondents.

Our study uncovered the top five drivers of negative hospital ratings were:

• Doctor/physician
• Emotional support
• ICU/CCU
• Nurse/Nurse aide
• Respect to patient

Our study found that people who had negative feedback related to any of these themes were between 200% and 250% more likely to downgrade the overall hospital rating.

CMS publicly reports hospital-level HCAHPS scores and star ratings.
Here’s how to access them:

Step 1: Visit Medicare Care Compare
Go to Medicare.gov and select “Care Compare.”

Step 2: Search by hospital name
Enter the hospital’s name or location.

Step 3: Review star ratings and domain scores
You can view:

• Overall summary star rating
• Individual HCAHPS domain scores
• Top-box percentages

Step 4: Download raw CMS data
For detailed analysis, visit data.cms.gov and download the HCAHPS dataset.

HCAHPS scores are directly tied to the Hospital Value-Based Purchasing (VBP) Program.

2% Medicare withhold

CMS withholds 2% of Medicare payments from participating hospitals.
That pool of funds is redistributed based on performance.
Hospitals with stronger performance earn back more than 2%.
Hospitals with weaker performance may earn back less.

Person and Community Engagement Domain

HCAHPS measures contribute to the “Person and Community Engagement” domain within VBP.

This domain typically represents a significant portion of a hospital’s Total Performance Score.

Achievement vs. improvement scoring

Hospitals are scored in two ways:

• Achievement: Performance compared to national benchmarks
• Improvement: Performance compared to the hospital’s own historical baselineCMS awards the higher of the two scores for each measure.

Improving your HCAHPS score can lead to better patient outcomes, stronger staff morale, and increased revenue.

Here’s how to get started and improve your HCAHPS score.

Patients no longer seek healthcare services. Patients are looking for understanding, empathy, and individual recognition.

Our data shows that hospitals that prioritize individualized care are not only enhancing patient outcomes but also helping shape the future of healthcare.

Patients who are treated as unique are 12 times more likely to be a Promoter in Net Promoter Scores (NPS) for healthcare organizations.

Patients and consumers increasingly demand more from their healthcare organizations—and not just clinically.

The modern patient expects empathy, access, and relevance at every touchpoint of the care experience.

Meeting these expectations means treating patients as humans, not as data points.

We’ve seen a consistent increase in Likelihood-to-Recommend (LTR) from healthcare organizations that have adopted Human Understanding.

Take, for example, Gundersen Health System and M Health Fairview.

After implementing Human Understanding, Gundersen Health System’s NPS score grew by 3 points, and M Health Fairview saw a 4-point increase in its NPS scores.

Healthcare should no longer aim to return to a “new normal.” Instead, it should strive to redefine the patient experience by putting the individual at the heart of the system.

Rethink your approach to patient feedback.

Go beyond scores to collect qualitative data using open-ended survey questions.

Qualitative feedback is as important as numerical scores.

Harris Health Systems implemented a Meds-to-Beds program to deliver prescriptions from their pharmacy in under an hour.

The results?

Harris Health Systems met its HCAHPS patient satisfaction goals of 80% or higher.

Sally Sims, Director of Pharmacy at Ben Taub Hospital, a Harris Health Systems location, shared, “NRC Health gave us that critical metric to monitor and share. If you don’t have that, you don’t really know how you’re doing. So it’s really important to be data-driven and to have that feedback.”

NRC Health’s Natural Language Processing (NLP) tool mines open-ended patient survey comments to give healthcare professionals a glimpse into the patient experience.

Identifying trends in themes like communication and emotional support can reveal precise areas for improvement.

Purposeful Nurse Leader Rounding involves unit leaders connecting directly with patients to address concerns, validate care, and enhance trust.

Our research indicates Nurse Leader Rounding can positively impact HCAHPS scores.

Patients who experienced Nurse Leader Rounding saw a 79% improvement in HCAHPS scores compared to 46% who did not.

PIH Health Good Samaritan Hospital is a great example of how improving nurse communication can impact HCAHPS.

After improving nurse communication, PIH Health Good Samaritan Hospital received 100% on the “Would you recommend this hospital?” question.

It also reduced call-light usage, improved patient assessments, and created a smoother transition between shift handoffs.

Timely and thoughtful follow-up is crucial. Patients may be unsure of treatments, prescriptions, and follow-up visits.

Automated discharge call programs can help answer patient questions after discharge.

Hospitals can improve both perceptions of responsiveness and nurse-patient communication scores by creating a discharge process.

For example, at McLeod Health, 83% of patients who interacted with an automated system gave top HCAHPS scores, compared to 76% who did not.

Quickly resolving patient grievances establishes trust and loyalty.

In our research, if service recovery was not implemented within 24 hours, HCAHPS scores fell by 1%. If service recovery was not met within 48 hours, HCAHPS scores declined by 5%.

If hospitals implement workflows to assess real-time feedback and empower teams to rectify patient concerns within 24 hours, there is a chance for better HCAHPS scores.

Missy Bartels, MSN, RN, CCRN, Director of Critical Care Services and Pastoral Care Services at Bryan Medical Center, understands the importance of service recovery.

She shares, “You can never assume to understand the perception of the patient without asking the details. Truly, you have to sit-down and give time for a conversation, that one-on-one relationship-building, and really provide service recovery early and guide the patient experience to an excellent one every time.

You need to have the core: “What does this person value? What is their background? What are the things that truly matter the most to them—family, friends, communication, etc.”

HCAHPS gives hospitals the chance to reimagine how healthcare systems engage with their patients.

These surveys offer insights into care delivery and foster stronger relationships with patients by placing their voices at the center of improvement efforts.

Hospitals can achieve transformational improvements by leveraging HCAHPS data and implementing evidence-based strategies like Nurse Leader Rounding and automated discharge calls.

Tools like NRC Health’s CAHPS solutions simplify compliance while amplifying patient voices through seamless, innovative technologies.

It’s time to enhance the human experience in healthcare and foster trust, loyalty, and satisfaction.

Partner with NRC Health today to elevate your HCAHPS strategy and improve patient care. Contact us today!