HCAHPS | Hospitals

What HCAHPS Measures

The patient's perspective — standardized so it can be compared.

The Hospital Consumer Assessment of Healthcare Providers and Systems survey — HCAHPS, also called Hospital CAHPS — is a standardized questionnaire administered to a random sample of adult inpatients after discharge. It has been publicly reported since 2008 and is now the primary source of patient experience data in hospital quality measurement.

The standardization is what makes it valuable. Before HCAHPS, hospitals collected patient satisfaction data using different questions, different scales, and different methodologies — making comparisons meaningless. HCAHPS uses the same questions across every participating hospital in the country, with the same response options, the same survey administration rules, and the same adjustment methods. The result is a dataset that supports genuine hospital-to-hospital comparison.

Scores are adjusted for differences in patient mix — hospitals serving older, sicker, or less English-proficient patients are not disadvantaged by those differences in the HCAHPS comparison.

⭐

Star Rating + Payment Connection

HCAHPS results populate Group 4 (Patient Experience) of the Overall Hospital Star Rating. They also feed the Patient- and Caregiver-Centered Experience domain of the Hospital Value-Based Purchasing program, where performance affects Medicare payment directly. HCAHPS is one of the few measures that simultaneously affects a hospital's star rating and its reimbursement.

The 10 Survey Domains

Ten areas of the patient experience, each scored independently.

HCAHPS covers ten distinct topics. Eight are composites or single-item measures drawn from survey questions; two are global rating items. Each domain produces its own score that is reported publicly and used independently in quality calculations.

Nurse Communication

How often nurses explained things clearly, listened carefully, and treated patients with courtesy and respect. One of the highest-weighted domains.

"How often did nurses communicate well with you?"

Doctor Communication

How often doctors explained things clearly, listened carefully, and treated patients with courtesy and respect.

"How often did doctors communicate well with you?"

Responsiveness of Hospital Staff

How quickly staff responded when patients called for help and when they needed to use a restroom or bedpan. A measure of operational attentiveness.

"How often did you get help as soon as you wanted?"

Communication About Medicines

How often staff explained the purpose of new medications and described potential side effects in a way patients could understand.

"How often did staff explain medicines before giving them?"

Discharge Information

Whether patients received written discharge instructions and whether staff explained the purpose of those instructions before leaving the hospital.

"Did you receive written information about recovery?"

Care Transition

Whether patients felt staff took their preferences and values into account, understood their responsibilities after discharge, and had a good understanding of their care. A newer domain reflecting post-discharge coordination.

"Did you understand your care when you left?"

Cleanliness of Hospital Environment

How often patients felt their hospital room and bathroom were clean. A patient-perceived cleanliness measure — not an infection control measure.

"How often were your room and bathroom clean?"

Quietness at Night

How often the area around patients' rooms was quiet at night. Noise disrupts sleep and recovery — this domain measures a basic environmental condition of the hospital stay.

"How often was the area around your room quiet at night?"

Overall Hospital Rating

Patients rate the hospital on a 0–10 scale. The reported metric is the percentage of patients who gave a rating of 9 or 10 — the "top-box" score used for all HCAHPS comparisons.

"Using a 0–10 scale, how would you rate this hospital overall?"

Willingness to Recommend

Whether patients would definitely recommend the hospital to friends and family. The top-box percentage — patients who answered "definitely yes" — is the reported metric.

"Would you recommend this hospital to friends and family?"

How Scores Are Reported

Top-box percentages, linear mean scores, and star ratings.

HCAHPS results appear in multiple formats depending on how they are being used — for public reporting, for the star rating calculation, or for HVBP payment calculations. Understanding which format you are reading matters.

Three Ways HCAHPS Scores Appear

Each format serves a different purpose. The underlying survey data is the same — only the aggregation changes.

Top-Box %

The percentage of patients who gave the most positive response to each question — "Always" for frequency items, 9 or 10 for the overall rating, "Definitely yes" for the recommendation question. This is the primary public-facing format on Care Compare.

Linear Mean Score

A continuous score that converts survey responses to a 0–100 scale for each domain, weighted and averaged. Used in HVBP payment calculations because it is more sensitive to variation than top-box percentages.

Star Rating (HCAHPS)

A separate 1–5 star rating published specifically for HCAHPS performance — distinct from the Overall Hospital Star Rating. Calculated from a composite of the ten domain scores using a clustering methodology similar to the overall star rating approach.

ℹ️

Survey administration rules matter. Hospitals can use mail, telephone, interactive voice response, or mixed-mode surveys — but must follow CMS-approved protocols. A minimum number of completed surveys (typically 300 over four quarters) is required before a hospital's scores are publicly reported. Hospitals below this threshold are excluded from HCAHPS comparisons.

Sources

CMS Hospital Downloadable Database Data Dictionary, January 2026 — CMS Provider Data Catalog
HCAHPS Survey — Official Website — hcahpsonline.org
HCAHPS Fact Sheet — CMS.gov