Development of the Revised CAHPS Hospice Survey

Why It Matters

A simpler, more relevant survey can boost hospice participation and generate clearer quality metrics, directly influencing Medicare reimbursement and public reporting. It also helps providers address culturally sensitive care without overburdening families.

Key Takeaways

• Survey shortened, reducing respondent burden for over 4,000 hospices
• Added items on patient wishes and cultural beliefs
• Confusing terms like 'cultural practices' removed after caregiver feedback
• Single-item caregiver training measure replaces multi-item composite
• Consolidating symptom items risks loss of detailed clinical data

Pulse Analysis

The CAHPS Hospice Survey has been a cornerstone of CMS’s quality reporting program since 2015, mandating monthly feedback from families of hospice patients. As hospice utilization grows, the original instrument’s length and complexity began to hinder response rates and obscure actionable insights. By engaging clinicians, policymakers, and patient advocates, CMS recognized the need to modernize the tool, ensuring it captures the nuances of end‑of‑life care while remaining feasible for over 4,000 providers nationwide.

To redesign the survey, researchers performed a plain‑language review and an extensive environmental scan, then drafted new items reflecting emerging priorities such as honoring patient wishes and acknowledging diverse cultural beliefs. Seven rounds of cognitive interviews with 59 family caregivers revealed that terms like “respecting the patient’s wishes” resonated, whereas phrases such as “cultural practices” caused confusion. The study consequently added “cultural beliefs” to spiritual‑support questions and consolidated multi‑item composites—particularly caregiver‑training—into single, clearly defined items, preserving essential information while trimming redundancy.

The revised instrument promises several industry benefits. A shorter, clearer questionnaire is likely to improve completion rates, delivering richer data for CMS’s public reporting and influencing hospice reimbursement tied to quality metrics. However, merging symptom items may sacrifice granular clinical detail, prompting providers to supplement survey data with internal assessments. Ongoing monitoring will be essential to balance brevity with depth, ensuring the CAHPS Hospice Survey remains a reliable barometer of patient‑centered, culturally competent end‑of‑life care.