What Are HHCAHPS Scores? 4 Patient-Centered Strategies to Improve Your Outcomes

Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) is a national, standardized, and publicly reported 34-question survey that measures the experiences of home health care patients receiving skilled home care from Medicare-certified agencies.

HHCAHPS is also one of the three outcomes measures reported in the Home Health Value-Based Purchasing model (HHVBP), representing 30 percent of agencies’ overall quality scores (along with 35 percent for Claims-based and OASIS-based measures). What this means is that under HHVBP, low patient satisfaction will result in a drop in reimbursement—and referrals.

HHCAHPS is not only reliant on outcomes but also the patient’s overall experience, so customer service skills are going to be vital for success. Because most of these are subjective measures based on the experiences of patients, it’s not as straightforward as correctly inputting data into the OASIS. But the good news is that you can still boost your HHCAHPS scores by improving metrics with tools to track satisfaction and remediate areas of low performance, training staff on person-centered care, and educating patients on how to better manage their own conditions.

How is HHCAHPS measured?

The measures that determine your total HHCAHPS score are:

• Care of Patients
• Communications
• Specific Care Issues
• Overall Rating
• Willingness to Recommend

Your score is broken down into three sections—35 percent of your score will be claims-based, 35 percent will be OASIS-based, and 30 percent will be derived from your agency’s HHCAHPS scores. Each measure type is then broken down further into different measures that carry different Total Performance Score (TPS) points. 

Your TPS scores will be added up and marked up to a maximum 100 TPS points. For example, if you hit the benchmark for Care of Patients in the HHCAHPS category, you’ll get the full 6.00 points. But if you fall short on the Communication measure, you’ll lose some amount of points from the 6.00 as appropriate. The higher your Total Achievement Score, the more likely you are to get a positive payment adjustment beginning in 2025.

Scoring will be measured in two different ways: Achievement Threshold and Improvement Threshold. The Achievement Threshold score measures your agency’s performance against everyone else while the Improvement Threshold score measures your performance during the performance year (2023) against your own baseline year (2022). CMS will use whichever of these two scores is higher.

Because HHCAHPS relies on patient response vs. a care provider input (i.e. OASIS), it can be a little more difficult to ensure participation. That’s why each measure description relies on a calculation that changes based on the number of respondents. 

The numerator in each of the measures is the number of respondents who gave the highest positive response to each question, and the denominator is the total number of respondents who answered the question. If one question has a denominator of 200 and another 150, that would indicate that not everybody answered the second question—perhaps they didn’t understand it, or just skipped the last couple questions. We want the highest possible respondents, so it’s important to consider that and see what is being scored, and targeting approaches toward those questions to encourage higher response.

Strategies to Improve HHCAHPS Metrics

Let’s take a deeper look at the first item, Care of Patients.

For the first three questions, the response categories are ‘Never, Sometimes, Usually, and Always,’ and we’ll want to strive for ‘Always.’ For the last, the desired answer is ‘No.’ Here are some strategies to achieve the optimal responses.

Q9. – Informed and Up-to-Date

Is your staff aware of the plan of care, what is happening with patients, and what has changed since their last visit? This may be the home care nurse’s first visit to the patient, so it’s important that they review the plan of care before they arrive to make sure they’re up to date with the patient’s condition. A seamless transition of care will help make the patient feel like they’re being cared for by a cohesive team, not being passed off from nurse to nurse. And if the patient has had an appointment with their primary care provider between visits, ask them about it and engage with them to see what happened. This will help gather important information about their current condition and also help them feel valued and heard.

Q16 – Gentle care

If a patient needs to go through a potentially uncomfortable procedure on their next visit, like wound care or therapy, it can help to contact your patient and remind them to take any appropriate medications for pain thirty to sixty minutes before arrival. This way, the medicine has had time to take effect, lessening the discomfort or pain of the procedure that is going to be performed. You should also periodically check in during the procedure and see how the patient is handling it and make adjustments as needed—maybe we need to slow down or saturate the dressing more—and be sure to look for nonverbal cues as well.

Q19 – Courtesy and Respect

Many times patients might not know exactly what is happening when beginning a procedure, or perhaps they started off on the wrong foot with a bad experience at the hospital before their care transition. Make sure to address their concerns, validate them, and put them at ease when procedures are to be performed. And since we’re performing care in their house, that same courtesy needs to be extended to their home. Do they prefer communication through text or phone call? Do they want to receive the call or is it better if a family member helps? When is the best time to call and what time of day do they want the visit to occur? Keeping these considerations in mind helps center the patient and respect their wishes.

Q24. – Problems with the Agency

Nurses are required to give the patient the contact information of a clinical manager at the agency—but how easy is it for the patient to actually follow through if necessary? First, make sure the patient knows where this information is so they can express any problems with care they received. Then, map out what the process looks like. Is someone available to pick up their call or return their call in a prompt manner? Are they getting passed around to two or three people before reaching someone who can help? Customer service-minded phone calls aren’t usually anyone’s favorite experiences, so getting this process ironed out can go a long way toward turning a negative patient experience into a positive interaction.

Guidelines on the HHCAHPS Survey

You can help your staff prepare by giving them a copy of the HHCAHPS survey so that they can understand what exactly they’re being measured on. It’s critical to remember that staff can see the survey, but you’re not allowed to give patients a copy of the HHCAHPS from your agency.

Below are actions agencies cannot do regarding the HHCAHPS survey:

− Provide a copy of the survey to patients

− Include, verbatim, words or phrases from the survey in promotional materials

− Attempt to influence responses

− Offer incentives for participating or not participating in the survey

− Help a patient answer questions

− Ask a patient why a response was given

Agencies can inform patients they may be asked to respond to a survey, but all patients must be notified of this. You can also ask patient/caregivers questions to promote well-being:

− Did you understand what we reviewed?
− Do you have any additional questions?
− How can we communicate with you better?

HHCAHPS Conclusion

Optimizing HHCAHPS and boosting HHVBP scores is going to be an ongoing process that can continually be worked on over time. To set your staff up for success, it’s vital to educate all staff on soft skills and customer service best practices. Make sure they are trained on the basics of how to answer the phone, how to close out encounters with patients, and how to respond when something unexpected may occur.

Review processes and common scenarios: What does your scheduling process look like? When is your staff expected to call patients? What is covered in your initial welcome call? What happens when a patient calls in? What does a medication review look like? Asking these questions and reviewing your processes can really help shore up any deficiencies and provide the best experiences possible to set your agency up for success both in the short and long term.

How MedBridge Can Help With HHCAHPS

MedBridge is constantly working to improve your experience and help you thrive under HHVBP. Here are a few ways we’re working to help you prepare for future success.

MedBridge In-Home Essentials: Everything Your Agency Needs for Clinical Excellence

MedBridge In-Home Essentials is a comprehensive end-to-end platform that supports nurses and staff from day one and beyond, helping boost staff retention and improve outcomes. It includes:

Home Health Onboarding Solution
With more care shifting to the home, quickly preparing new hires for the field is essential. Our CHAP-verified onboarding solution allows agencies to boost staff readiness with effective, engaging education and easy-to use delivery and reporting tools.
Clinical Procedure Manual
The MedBridge Clinical Procedure Manual is a tablet-ready solution that enables nurses to quickly find high-quality procedure instructions, demonstrations, and tips, all certified and expert reviewed. With quick access to the resources they need, home health nurses can have confidence in the care they provide and deliver better outcomes.
OASIS Training Solution
Poor OASIS documentation can be costly. Provide your staff with expert-led onboarding and refresher training to ensure accurate outcomes and reimbursement.
Patient Engagement Solution
Our comprehensive Home Health Patient Engagement Solution allows agencies to boost patient activation and motivation between visits with user-friendly digital tools.
Skills & Competency Manager
This comprehensive training and skills assessment solution allows home health agencies to prepare new hires for the field as quickly as possible while also meeting regulatory requirements, improving quality of care, and boosting patient satisfaction. It includes:
– Digital Skills Checklist
Customize training programs to target identified skill gaps.
– Video-Based Skills Library
Boost knowledge retention and master home health- and hospice-specific skills with bite-sized lessons.
– Reporting & Analytics Dashboard
Assign checklists, simplify preceptor assessment, and review skill acquisition