The World Has Gone Digital — Why Hasn’t the CAHPS Survey?

The World Has Gone Digital — Why Hasn’t the CAHPS Survey? January 30, 2021

Technology has moved at a dizzying pace over the past few decades, with innovations like the Internet and smartphones completely transforming the way we go about our day-to-day lives. With just a few taps or clicks, our connected devices now provide us access to unlimited information, entertainment, and convenience right at our fingertips.


Initially, many businesses were threatened by this upheaval in the system — but eventually, virtually all of them came to see it as the opportunity it is, and evolved to accommodate this new way of life. Industries like communications, retail, food service, and even historically slower-moving industries like finance quickly adapted to keep up in the competitive landscape — but others, like healthcare, are still lagging behind the rest, as The Economist recently documented.


Of course, there have been incredible advancements in healthcare over the years — breakthroughs in medicine, surgical procedures, and our understanding of the human body now allow us to diagnose and treat patients better than ever — but many people are surprised to learn just how much this highly-regulated industry relies upon old-fashioned and outdated systems. Case in point: the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

Challenges With the CAHPS Survey

Since July 2007, hospitals have been required by the Centers for Medicare & Medicaid Services (CMS) to collect, submit, and publicly report patient satisfaction surveys through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in order to receive full Medicare payment. Unfortunately, to the detriment of more timely and accurate data, HCAHPS surveys can be administered only by mail, telephone, mail with telephone follow-up, and/or Active Interactive Voice Response (IVR).

These traditional survey methods place an excessive financial and administrative burden on providers, who often must turn to outside vendors to chase down patients and solicit responses on their behalf. And with just two vendors comprising 90 percent of the market, providers have little choice in who they work with. While it is not yet mandatory, the market for Outpatient and Ambulatory Surgery (OAS) CAHPS survey administrators is equally restrictive,

Beyond the administrative challenges of the CAHPS survey, the retrospective data it captures is only of limited use to healthcare organizations. CAHPS regulations stipulate that patients must be surveyed between 48 hours and six weeks after discharge. Add to that the time it takes for their responses to be recorded and reported back to you, and the data is even more stale. By the time you become aware of an unhappy patient, there’s little you can do to make it up to them.

As the world continues to embrace digital communication, fewer and fewer patients take the time to respond through mail or on the phone — after all, they’re not being reached on their preferred channels.

“People are becoming accustomed to the technology and efficiency of online surveys. Fewer people are responding to mail surveys and long phone surveys turn people off,” wrote Charles Kahn and Claudia Salzberg of the Federation of American Hospitals in a co-authored article. “When an electronic survey is not an option we are seeing survey response rates decline.”

This trend can be clearly seen in the graph below from Health Affairs.

Because of these constraints, providers do not have the timely, robust data they need to make meaningful improvements to the patient experience. And it’s not as if we don’t have the technology or demand to correct the issue. If you can order food, buy clothes, make financial transactions, and even sign legal documents digitally, why shouldn’t you be able to take a survey the same way?

Solving the CAHPS Problem

Over the past few years, we have seen widespread adoption and usage of digital tools. As of June 2019, 96 percent of all Americans owned a smartphone — a figure that spans across demographics, including vulnerable populations such as the elderly and housing insecure. CMS itself has rightfully pointed out the persistent myth of low technology use among seniors in a recent blog post: “Sadly, this type of ageism isn’t anything new. But it is inaccurate. CMS research has demonstrated repeatedly that many people with Medicare own smartphones and tablets, download apps, and use them all the time.”

Rather than excluding populations, healthcare experts believe email- and text-based CAHPS administration presents an opportunity to amplify the voices of marginalized groups.

“New, more patient-centered and efficient modes of survey administration will enable more rapid feedback that can enhance quality improvement and more fully represent the experiences of patient populations that have been hard to reach through traditional paper and telephone methods,” wrote representatives from Kaiser Permanente and the Patient Experience Policy Forum in a co-authored opinion piece.

And this digital adoption is only increasing, especially in the wake of the pandemic. With so many practitioners shifting to a remote model to slow the spread of COVID-19, patients are becoming more and more comfortable using smartphones, laptops, and tablets for healthcare.

Savvy providers are increasingly turning to digital solutions to supplement the feedback they get from CAHPS, but it shouldn’t be a siloed experience. Allowing patients to respond via email and smartphone would lead to higher response rates, quicker turnaround time, and, most importantly, the ability for providers to identify and resolve patient experience challenges as they crop up.

We urge CMS to modernize the CAHPS survey program to include digital means of survey administration, and encourage providers to embrace real-time patient feedback. Not only will this improve the CAHPS survey-taking experience for patients — it might just lead to better overall health outcomes.


Edward Shin, MD

CEO and Co-Founder

Previously co-founded WellApps and Healogica. Built and led a healthcare team at Gerson Lehrman Group. Director of Content Development at Healthology. Ed received his BA and MD from the University of Pennsylvania School of Medicine. Completed his residency in Internal Medicine at Columbia Presbyterian Medical Center in New York and is board-certified in Internal Medicine.

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