TABLE OF CONTENTS

Healthgrades Outstanding Patient Experience Award^™

HCAHPS Information

Ten Patient Experience Measures

How Patients Respond and What We Display

Data Acquisition

Eligibility for the Outstanding Patient Experience Award

Designating the 2023 Outstanding Patient Experience Award Recipients

Limitations of the Data Models

References

Healthgrades Outstanding Patient Experience Award™

The Healthgrades Outstanding Patient Experience Award™ recognizes hospitals that provide an overall outstanding patient experience. Healthgrades overall patient experience scoring methodology uses Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey data from the Centers for Medicare and Medicaid Services (CMS).

Healthcare leaders have defined patient experience as the sum of all interactions, shaped by a healthcare organization’s culture, that influence patients’ perceptions across the continuum of care.¹ 

The purpose of the HCAHPS survey is to collect information about patients’ perspectives of their care in the hospital that allows objective and meaningful comparisons of hospitals on topics that are important to consumers. The HCAHPS questionnaire addresses patients’ perceptions of care relative to the frequency and consistency of behaviors demonstrated by the hospital care team during hospital stays.

Specifically, the HCAHPS survey asks respondents to rate various areas of hospital care based on if the measured action took place, and if so, how frequently the patient perceived the measured action to take place. In this way, HCAHPS seeks to measure how often key behaviors occur rather than how well hospitals perform those behaviors.

For this standardized patient experience survey, a random sample of hospital patients was invited to complete a 29-question survey within 48 hours to six weeks after discharge. Patients were surveyed throughout the year, and the survey was administered by mail, telephone, mail with telephone follow-up, or interactive voice recognition.

Participating hospitals may either use an approved survey vendor or collect their own HCAHPS data (if approved by CMS to do so). CMS’s goal is for each hospital to have at least 300 completed surveys annually. To ensure that publicly reported HCAHPS scores allow fair and accurate comparisons across hospitals, CMS performs adjustments that eliminate any advantages or disadvantages that might result from the methods used to survey patients or characteristics of patients. For more information on HCAHPS, see www.hcahps.org.

Healthgrades uses HCAHPS survey data for evaluating patient experience at the hospital for several reasons:

• The HCAHPS survey includes survey responses from a representative sample of patients visiting each hospital.
• The HCAHPS survey is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.
• The HCAHPS survey allows for objective and meaningful comparisons of hospitals locally, regionally and nationally on topics that are important to healthcare consumers.

Ten Patient Experience measures are publicly reported in hospital quality profiles on Healthgrades.com. The 19 questions related to hospital care from the survey are rolled up to provide ten measures. These questions, along with an additional ten questions, include items used for screening that direct patients to relevant questions, items used for patient mix adjustment, and items used for congressionally mandated reporting:

1. Overall Rating - How do patients rate the hospital overall?
2. Recommendation to Family/Friends - Would patients recommend the hospital to friends and family?
3. Communication With Doctors - How often did doctors communicate well with patients?
4. Communication With Nurses - How often did nurses communicate well with patients?
5. Responsiveness of Hospital Staff - How often did patients receive help quickly from hospital staff?
6. Communication About Medicines - How often did staff explain medicines before giving them to patients?
7. Cleanliness - How often were the patients' rooms and bathrooms kept clean?
8. Quietness - How often was the area around patients' rooms kept quiet at night?
9. Discharge Information - Were patients given information about what to do during their recovery at home?
10. Care Transition – How well did hospital staff communicate to patients about their health and care needs as they were leaving the hospital?

The following describes how patients respond to the questions, as well as how we display the measures on a Healthgrades hospital quality profile.

For the Overall Ratings, patients use a scale of 1 to 10 from worst to best, respectively. The percentage of patients who rated the hospital high (9 or 10) is compared to the national average of patients who rated their hospitals high.

For the Recommendation to Family/Friends question, patients indicate if they would recommend the hospital by choosing one of four options: definitely yes, probably yes, probably no, or definitely no. The percentage of patients who answered yes, they would definitely recommend the hospital is compared to the national average of patients who also responded definitely yes.

For all other questions, patients answer with never, sometimes, usually, or always. The percentage of patients who answered always is compared to the national average of patients who responded always.

Healthgrades evaluates patient experience in U.S. hospitals using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey data released in January 2022 by the Centers for Medicare and Medicaid Services (CMS), covering patients discharged between January 1, 2021 and December 31, 2021.

To be eligible for the Healthgrades Outstanding Patient Experience Award, a hospital must meet clinical quality thresholds and have data for a minimum number of HCAHPS surveys.

1. Clinical Quality Threshold – To be eligible, a hospital must be in the top 80% of hospitals for clinical quality as ranked by composite z-score across the conditions and procedures that Healthgrades evaluates using Medicare data. Hospitals, such as cancer centers, that have patient experience data but no Healthgrades ratings, are included in the “0 conditions and procedures evaluated” category. (See step 1 below, Categorize eligible hospitals into groups.)
2. Minimum Number of HCAHPS Surveys – Due to reduced patient volumes seen at hospitals, a hospital must have data for at least 75 HCAHPS surveys to reliably assess performance.

To recognize hospitals that provide an overall outstanding patient experience, Healthgrades groups hospitals into four categories and creates standardized patient experience scores for each hospital using data from HCAHPS reported by CMS. Healthgrades then identifies hospitals in the top 15% of eligible hospitals in the nation with the highest overall patient experience scores from each of the four hospital type categories. Specifically, the process involves the following four steps.

1. Categorize eligible hospitals into groups.

Healthgrades groups hospitals into four categories based on the hospital bed size and number of cohorts (conditions and procedures) evaluated by Healthgrades. The creation of these four groups was informed by a k-means cluster analysis using hospital attribute variables, including: teaching status, hospital size, location, number of cohorts evaluated, and bed size. This analysis was conducted to identify variables that represent hospital categories with the least amount of inherent bias, so that all hospitals are represented equally in our patient experience methodology.
Two variables, bed size and number of cohorts evaluated, delineated the largest separation among patient experience scores, and thus, defined the categories of hospitals into four groups. The four groups are defined as:

• Hospitals with Healthgrades evaluations for zero cohorts
• Hospitals with Healthgrades evaluations for 9 or fewer cohorts and fewer than 80 beds
• Hospitals with Healthgrades evaluations for 10 or more cohorts and fewer than 80 beds
• All other facilities

1. Create z-scores for each HCAHPS measure.

Healthgrades creates a z-score for each HCAHPS measure for each hospital, which estimates how the hospital scored compared to the average for all hospitals within each group.
Nine of the ten HCAHPS measures have three possible responses indicating a positive response, neutral response, and negative response (such as, Always, Usually, or Sometimes/Never). We do not use the neutral responses. For these eight measures, Healthgrades creates two z-scores, which represent the negative and positive responses.

The tenth HCAHPS measure question, (Discharge Information: Were patients given information about what to do during their recovery at home?) has two possible responses—positive or negative (Yes or No). We do not use the negative responses. For this measure, Healthgrades creates one z-score, which represents the proportion of positive responses.

Healthgrades uses the following formulas for these 19 z-scores representing positive and negative responses:

For the negative responses, Healthgrades uses the following formula to calculate the z-scores. A lower percentage is favorable.

                Z-score = (HCAHPSMeasure MEAN – HCAHPSMeasure HOSPITAL)

                                     HCAHPSMeasure STDDEv

where:        HCAHPSMeasure MEAN = the average response rate for the measure across all hospitals within the category

        HCAHPSMeasure HOSPITAL = the response rate for the measure at an individual hospital

        HCAHPSMeasure STDDEV = the standard deviation of the response rate for the measure across all hospitals in the category

For the positive responses, Healthgrades uses the following formula to calculate the z-scores. A higher percentage is favorable.

                Z-score = (HCAHPSMeasure HOSPITAL – HCAHPSMeasure MEAN)

                                     HCAHPSMeasure STDDEV

where:        HCAHPSMeasure MEAN = the average response rate for the measure across all hospitals within the category

        HCAHPSMeasure HOSPITAL = the response rate for the measure at an individual hospital

        HCAHPSMeasure STDDEV = the standard deviation of the response rate for the measure across all hospitals in the category

1. Create an overall patient experience score.

To create an overall patient experience score for each hospital, Healthgrades calculates a weighted average of the 19 HCAHPS z-scores. In the weighting process, two measures receive more weight than the others did. The “Overall” HCAHPS measure and the “Recommendation to Family/Friends” HCAHPS measure each carried a weight of 25%. All other scores are weighted equally accounting for the remaining 50%.

1. Designate recipients of the Outstanding Patient Experience Award.

Hospitals from each category are then listed according to their overall patient experience score, from highest to lowest. Hospitals in the top 15% with the highest overall patient experience scores in their respective categories are designated as Outstanding Patient Experience Award recipients.

While these models are valuable in identifying hospitals that have higher patient satisfaction, one should not use this information alone to determine the quality of care provided at each hospital. The models are limited by the following factors:

• Not all of the nation’s hospitals have HCAHPS survey data.
• Although Healthgrades takes steps to carefully compile these data using its methodology, no techniques are infallible; therefore, some information may be missing, outdated or incorrect.

A high rating or award for a particular hospital is not a recommendation or endorsement by Healthgrades of a particular hospital. It means that the data associated with a particular hospital has met the foregoing qualifications. Only individual patients can decide whether a particular hospital is suited for their unique needs.
Also, note that when multiple hospitals reported to CMS under a single provider ID, Healthgrades analyzed patient outcome data for those hospitals as a single unit. Throughout this document, therefore, “hospital” refers to one hospital or a group of hospitals reporting under a single provider ID.

For a downloadable PDF, check out the 2023 Outstanding Patient Experience Award Methodology.

1. Defining Patient Experience. (2023). https://www.theberylinstitute.org/page/DefiningPatientExp