What is the Survey of Patients' Hospital Experiences (HCAHPS)?

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a national, standardized survey of hospital patients. HCAHPS (pronounced "H-caps") was created to publicly report the patient's perspective of hospital care. The survey asks a random sample of recently discharged patients about important aspects of their hospital experience.

The HCAHPS results posted on Hospital Compare allow consumers to make fair and objective comparisons between hospitals, and of individual hospitals to state and national benchmarks, on ten important measures of patients' perspectives of care.

HCAHPS was developed by a partnership of public and private organizations. Development of the survey was funded by the Federal government, specifically the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ).

What are the Hospital Outcome of Care Measures?

"Outcome of Care Measures" show what happened after patients with certain conditions received hospital care. The death rates focus on whether patients died within 30 days of their hospitalization. The rates of readmission focus on whether patients were hospitalized again within 30 days. Death rates and rates of readmission show whether a hospital is doing its best to prevent complications, teach patients at discharge, and ensure patients make a smooth transition to their home or another setting such as a nursing home.

The hospital death rates and rates of readmission are based on people with Medicare who are 65 and older. These rates are calculated using Medicare enrollment and claims records, and a complex statistical procedure. The death rates and rates of readmission are "risk-adjusted", meaning that the calculations take into account how sick patients were when they went in for their initial hospitalization. When the rates are risk-adjusted, it helps make comparisons fair and meaningful.

What is Medicare Payment and Volume?

Patients that have similar clinical characteristics and similar costs are assigned to an MS-DRG. The MS-DRG will be associated with a fixed payment amount based on the average cost of patients in the group. Patients are assigned to a MS-DRG based on diagnosis, surgical procedures, age and other information. Medicare uses this information that is provided by hospitals on their bill to decide how much they should be paid. Hospital Compare shows information for each hospital on selected MS-DRGs from October 2007 through September 2008. If a MS-DRG has "Complications" or "Comorbidities" in its title,it means the hospital may have treated more complicated patients.

Because MS-DRGs are highly technical, patients and other consumers may need to work with a doctor or other healthcare provider to understand these terms as well as the payment and volume information. CC refers to complications or comorbidities. MCC refers to major complications or comorbidities.When Medicare pays a hospital based on the MS-DRG, it takes into account the following (case mix):

• How bad the illness is or if the patient dies (severity of illness)
• How likely it is that the patient will get better or get worse (prognosis)
• What would happen if the patient does not receive immediate or continuing care (need for intervention)
• How much and what type of service the hospital needed to provide, such as lab work, X-rays or physical therapy (resource intensity)

The payment and volume information is for acute care hospitals. Critical access hospitals (CAH) and Children's Hospitals are not included because they are paid using another method.

Median Medicare Payments

Median Medicare payments for the same MS-DRG can vary. 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. 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 (disproportionate share)
• 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 (wage index). Note: The hospital's wage index is calculated using the hospital's payroll records, contracts and other wage related documentation

Range of Payments 25th 75th Percentile

Hospital Compare lets you compare the hospitals you select with other hospitals in your state and in the nation. The state and national amounts are shown as a range of payments (between the 25th percentile and the 75th percentile). This is the range of payments for the most typical cases treated for the MS-DRG. The information doesn't include unusually low payments for cases, such as when a patient was transferred to another facility before being fully treated. It also doesn't include unusually high payments for cases that are more complex and costly to treat. Only one number appears in this field when the 25th and 75th percentiles are the same.