Hospital Compare is a federal website operated by the Centers for Medicare and Medicaid (CMS). On this site (https://www.medicare.gov/hospitalcompare/search.html) CMS publishes hospital performance data collected about indicators of quality, a national patient satisfaction survey, as well as payment and volume information for each hospital. This quality and patient satisfaction data is required for all hospitals that treat Medicare patients. However, the patient satisfaction survey is collected from a random sample of all discharged adult patients.
Three types of quality information is available: outcome measures, process measures and rates of hospital acquired conditions. This information is collected on Medicare patients only submitted to CMS by each hospital. Outcome measures tell what happened after patients with certain conditions received hospital care. Examples of outcome measures are death rates within 30 days of discharge and rates of readmissions 30 days following hospital discharge. Process measures show, in percentage form or as a rate, how often a health-care provider gives recommended care; that is the treatment know to give the best results for most patients with a particular condition. Examples are the percentage of patients receiving smoking cessation information at discharge if the patient was admitted with an acute myocardial infarction (heart attack). Hospital-acquired conditions (HACs) are published as rates and are serious conditions that patients may get during an inpatient hospital stay. If hospitals follow evidenced based guidelines to treat and care for patients, these conditions are less likely to occur. Examples of HACs are objects accidentally left in the body after surgery, severe pressure sores and vascular catheter-associated infections.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS (pronounced “H-caps”), also known as the CAHPS® Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally. The HCAHPS survey is administered to adult patients across medical conditions between 48 hours and six weeks after discharge; the survey is not restricted to Medicare beneficiaries.
The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay. The survey contains 18 core questions about critical aspects of patients’ hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital). The survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support Congressionally-mandated reports.
The enactment of the Deficit Reduction Act of 2005 created an additional incentive for acute care hospitals to participate in HCAHPS. Since July 2007, hospitals subject to the Inpatient Prospective Payment System (IPPS) annual payment update provisions (“subsection (d) hospitals”) must collect and submit HCAHPS data in order to receive their full IPPS annual payment update. IPPS hospitals that fail to publicly report the required quality measures, which include the HCAHPS survey, may receive an annual payment update that is reduced by 2.0 percentage points. Non-IPPS hospitals, such as Critical Access Hospitals, may voluntarily participate in HCAHPS.
The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) includes HCAHPS among the measures to be used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program, beginning with discharges in October 2012.
Publicly reported HCAHPS results are based on four consecutive quarters of patient surveys. CMS publishes HCAHPS results four times a year, with the oldest quarter of patient surveys rolling off as the most recent quarter rolls on. HCAHPS results can be found on Hospital Compare (https://www.medicare.gov/hospitalcompare/search.html) and on HCAHPS On-Line, (www.hcahpsonline.org).
Payment and Volume Information
The payment and volume information reflects inpatient hospital services provided by hospitals to Medicare beneficiaries. The information is derived from hospital payment records. CMS posts this information for the public to see the cost to the Medicare program of treating beneficiaries with certain illnesses in their community. CMS believes a better understanding of the cost of care leads to more informed decision making, one more way beneficiaries can help improve the longer term financial health of the Medicare program. Payment and volume information can provide users with a general overview of hospitals’ experience with Medicare Severity Diagnosis Related Groups (MS-DRGs).
MS-DRGs are payment groups of patients who have similar clinical characteristics and similar costs. Each MS-DRG is associated with a fixed payment amount based on the average cost of patients in the group. MS-DRGs for which Medicare payment and volume data are available include common inpatient stays such as hospitalizations for heart failure and heart bypass surgery.
For individual hospitals, the median Medicare payment is published for each MS-DRG. The median payment refers to the midpoint of all payments to the hospital for a particular MS-DRG, that is, half the payments were lower and half the payments were higher than the median payment. The median hospital payments for the same MS-DRG can vary. A hospital can get a higher payment for any or all of the following reasons:
- It is classified as a teaching hospital
- It treats a high percentage of low-income patients (called a disproportionate share hospital)
- It may treat unusually expensive cases (outlier payments)
- It pays its employees more compared to the national average because the hospital is in a high-cost area. Note: A hospital’s Medicare payments are adjusted based on the wage rates paid by area hospitals based on their payroll records, contracts and other wage related documentation.
The volume displayed is the number of Medicare patient discharges for the selected MS-DRGs. Where applicable, the appropriate quality measures are displayed with each MS-DRG. However, there is not a direct relationship between the payment and volume information and the quality measure information. The quality measure information does not include the same cases associated with each MS-DRG.