Hospice-specific FAQs

CAHPS® Hospice Survey

Hospice-specific FAQs
     
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CAHPS Hospice Survey
Hospice-specific Frequently Asked Questions (FAQs)

Does my hospice need to participate? How does my hospice apply for an exemption from participation?

In general, all Medicare-certified hospices (identified by CMS Certification Number [CCN]) must participate in the CAHPS Hospice Survey in order to receive their full Annual Payment Update (APU). However, certain exemptions are granted by CMS for size or newness.

Exemption for Size

  • If your hospice has served fewer than 50 survey-eligible decedents/caregivers during the “reference period” (see table below) you can apply for an exemption from the CAHPS Hospice Survey. The reference year is the CY immediately prior to the CY for which the exemption is requested.

For example: If a hospice served fewer than 50 survey-eligible decedents/caregivers during the year from January 1, 2020 through December 31, 2020 (or from assignment of CCN), the hospice may apply for a CY 2021 annual exemption on the basis of size.

  • Exemptions on the basis of size are active for one year only. If your hospice remains eligible for this exemption in subsequent years, your organization will need to request this exemption on an annual basis.

"Reference Period" or Decedent Date of Death

Exemption Form Deadline

Exemption Request Review by CMS

Affects APU

Jan 1 to Dec 31, 2018

Dec 31, 2019

2020

FY 2021

Jan 1 to Dec 31, 2019

Dec 31, 2020

2021

FY 2022

Jan 1 to Dec 31, 2020

Dec 31, 2021

2022

FY 2023

Jan 1 to Dec 31, 2021

Dec 31, 2022

2023

FY 2024

FY – Fiscal Year

  • To apply for the exemption, the hospice must fill out and submit a Participation Exemption for Size Form located in the Participation Exemption for Size tab on the CAHPS Hospice Survey website (www.hospicecahpssurvey.org). The CY 2021 form will be available for submission until December 31, 2021.
  • The CY 2020 Participation Exemption for Size Form was available to complete until December 31, 2020.

Exemption for Newness

  • The exemption for newness is based on how recently the hospice received its CCN, also known as the Medicare Provider Number. The criterion for this exemption is that the hospice must have received its CCN on or after the first day of the performance year for the CAHPS Hospice Survey.

For the calendar year (CY) 2021 data collection period, hospices who received their CCN on or after January 1, 2021 are eligible for a one-time exemption for newness. For example, if a hospice receives its CCN any time in 2021, whether it is in January 2021 or December 2021, it is exempt from survey administration for the remainder of 2021. A hospice that receives its CCN any time in 2021 is required to start participating in the CAHPS Hospice Survey beginning with January 2022 decedents.

  • This is a one-time exemption for each hospice as identified by CCN
  • Hospices eligible for this exemption will be identified by CMS, as this exemption is based on when the hospice’s CCN is assigned. There is no form for hospices to submit.

Does my hospice need to have a contract with a survey vendor? 

  • If your hospice is exempt from participation because of size or newness, you will not need to contract with a survey vendor
  • If your hospice does not meet the exemptions for size or newness, then your hospice will need to select a survey vendor, negotiate a contract with the survey vendor, and authorize the survey vendor to collect and submit data on your hospice’s behalf. The approved survey vendor list is located under the left hand Approved Vendor List navigation button on the CAHPS Hospice Survey Web site.

How does my hospice authorize a CAHPS Hospice Survey vendor?

  • To authorize a survey vendor, a hospice representative must complete the CAHPS Hospice Survey Vendor Authorization Form found on the “Technical Specifications” page of the CAHPS Hospice website (www.hospicecahpssurvey.org/) and submit it to the RAND Corporation one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse.
  • The individual who completes this form for the hospice will be considered the CAHPS Hospice Survey administrator for that hospice. Hospices should also designate, on the form, an individual within the hospice organization to serve as the main point of contact with the CAHPS Hospice Survey project team and to review data submissions by the survey vendor.
  • This form must be signed and dated in the presence of a notary public, notarized, and sent to the RAND Corporation.
  • Note that, when completing the CAHPS Hospice Survey Vendor Authorization Form pertaining to multiple hospice agencies, it is appropriate to attach a list to the form (signed and dated by the CAHPS Hospice Survey administrator) of all the hospices (hospice names and CCNs). Please check the box on the form indicating that a separate document is attached and indicate the number of hospice names or CCNs listed on the separate sheet.
  • This form must be submitted to the RAND Corporation one calendar quarter (90 days) prior to the data submission deadline. If you have questions, contact the CAHPS Hospice Survey Data Coordination Team via email at: cahpshospicetechsupport@rand.org.

How does my hospice change a CAHPS Hospice Survey vendor?

  • If a hospice wishes to change CAHPS Hospice Survey vendors, it may do so only at the beginning of a calendar quarter. Note: A quarter is based on the CY and will correspond to the month of patient death. For example, Q4 2021 begins with October 2021 patient deaths (caregivers to be surveyed in January 2022).
  • To change a survey vendor, the hospice’s CAHPS Hospice Survey Administrator must complete the Authorization Form for Changing Survey Vendors found on the “Technical Specifications” page of the CAHPS Hospice Survey website (www.hospicecahpssurvey.org) and submit it to the RAND Corporation one calendar quarter (90 days) prior to the first time data will be submitted to the CAHPS Hospice Survey Data Warehouse by the new survey vendor.
  • This form must be signed and dated in the presence of a notary public, notarized, and sent to the RAND Corporation. During the public health emergency, the Authorization Form may be emailed to the RAND Corporation (cahpshospicetechsupport@rand.org). After the public health emergency ends, the hard copy notarized Survey Vendor Authorization Form will need to be sent to the RAND Corporation.
  • When completing the Authorization Form for Changing Survey Vendors pertaining to multiple hospice agencies, it is appropriate to attach a list to the form of all the hospices (hospice names and CCNs). Please check the box on the form indicating that a separate document is attached and indicate the number of hospice names or CCNs listed on the separate sheet. The list must be signed and dated by the CAHPS Hospice Survey administrator.

How does my hospice submit a sample file to the survey vendor? 

  • Your hospice will work with its contracted survey vendor to determine a date each month to submit the monthly decedents/caregivers list and counts of cases ineligible due to live discharges and voluntary requests for no contact (“no publicity”)
  • There is specific information that the hospice will need to provide to its survey vendor. This information can be found in Appendix D of the CAHPS Hospice Survey Quality Assurance Guidelines V8.0. This manual is available on the CAHPS Hospice Survey Web site, under the left hand Quality Assurance Guidelines tab.

How is the “primary informal caregiver” identified?

  • The hospice is responsible for identifying the primary informal caregiver that may be eligible to receive and respond to the CAHPS Hospice Survey. Please note, hospices should not necessarily prioritize a primary informal caregiver that is a family member over a friend, as one caregiver category does not automatically have preference over another.
  • The CAHPS Hospice Survey is designed to be administered to the person most knowledgeable about the care the decedent received at the hospice. Staff members or employees of the hospice or care setting in which the patient received care should not be considered primary informal caregivers.

How will my hospice access the CAHPS Hospice Survey Data Warehouse?

  • For your hospice to access and review the data submitted by your survey vendor, a login to the CAHPS Hospice Survey Data Warehouse (https://kiteworks.rand.org) is required. Hospices must submit a CAHPS Hospice Survey Data Warehouse Form located on the “Technical Specifications” page of the CAHPS Hospice Survey website (www.hospicecahpssurvey.org/).
  • The RAND Corporation will provide a login to the CAHPS Hospice Survey Data Warehouse. It is important to designate two people from your hospice to have access to the CAHPS Hospice Survey Data Warehouse in order to be able to review quarterly data submission reports.
  • Make sure to notify the CAHPS Hospice Survey Data Coordination Team of any staff changes by sending an updated CAHPS Hospice Survey Data Warehouse Form to cahpshospicetechsupport@rand.org.
  • Hospices will have their own folders in the CAHPS Hospice Survey Data Warehouse. Documents and files of interest to all survey vendors and hospices will be placed in the top-level folder of the CAHPS Hospice Survey Data Warehouse and will be visible and available for download by any authorized user of the CAHPS Hospice Survey Data Warehouse.
  • Hospices are responsible for accessing and reviewing the CAHPS Hospice Survey Data Submission Reports.
  • After a file has been submitted to the CAHPS Hospice Survey Data Warehouse, the survey vendor and hospice will receive an automated email confirming the file submission. This email is sent within two hours of the file upload.
  • Successfully submitted files will be put through a series of edit checks. Survey vendors (data administrator and backup data administrator) and hospices (data administrator and backup data Administrator) will receive a second email indicating that the CAHPS Hospice Survey Data Submission Reports from these edit checks are available for viewing in their respective folders on the CAHPS Hospice Survey Data Warehouse. Reports will be posted by 5:00 p.m. eastern standard time on the next business day after upload. CAHPS Hospice Survey Data Submission Reports for a hospice will include information only for that hospice.
  • Survey vendors and hospices will need to review their CAHPS Hospice Survey Data Submission Reports to determine what errors were found in the files, and survey vendors will be required to resubmit a corrected survey data file. A hospice will receive updated reports after new data are submitted for its hospice, until its data set has passed all edit checks.

Note: All hospices should review the Data Submission Reports after they are uploaded to their CAHPS Hospice Survey Data Warehouse folder.

If you have questions, contact the CAHPS Hospice Survey Data Coordination Team via email at: cahpshospicetechsupport@rand.org.


What reports are available to my hospice on the CAHPS Hospice Survey Data Warehouse?

Below is a brief overview of what is presented in your hospice’s reports. These reports will be posted to your hospice’s data warehouse folder within two days following an upload by your survey vendor. The four reports are:

  • Data Submission Detail Report (Part I): This report indicates whether or not the data submitted by your survey vendor was accepted and processed. If the uploaded file fails to conform to the correct XML specifications, the file will not be processed and the remainder of the reports will not be generated. A corrected file will need to be resubmitted prior to the data submission deadline.
  • Data Submission Detail Report (Part II): This report indicates if the submitted data passed data quality checks. If any values are out of range, “Data Value Checks Status” will show as “Rejected,” the report will list all of the errors in the file, and the survey vendor must submit a new file. If all data values pass the data quality checks, “Data Value Checks Status” will show as “Accepted,” and no further action is needed.
  • Survey Status Summary Report: This report lists whether a Hospice Record was accepted, the sample size, the number of decedent/caregiver administrative records, the number of valid survey status codes, and the number of completed surveys within the file. These are listed separately by month of death, and overall.
  • Review and Correction Report: This report lists the number of valid and invalid responses to each variable in the file.

When does the survey take place? 

Hospices are required to participate in the CAHPS Hospice Survey on an ongoing monthly basis.

  • Data collection for sampled decedents/caregivers must be initiated two months following the month of patient death
    • For example, if a patient dies in October 2021, a hospice may begin surveying that patient’s primary caregiver starting January 1, 2022
  • For more information on the survey administration timeline, refer to the left hand FAQs navigation button on the CAHPS Hospice Survey Web site

Can our hospice discuss the CAHPS Hospice Survey with decedents/caregivers?

  • If your hospice wants to let caregivers know that they may receive a survey and to encourage them to complete it, you must tell all caregivers. However, your hospice must not attempt to influence the caregivers to answer the CAHPS Hospice Survey questions in any particular way.
  • It is not permissible to show or provide the CAHPS Hospice Survey materials, including envelopes, to caregivers while they are in the hospice or at any time prior to the administration of the survey.
  • Your organization may communicate the name of the survey vendor that will be administering the survey to all caregivers during the hospice admission process.

Are there guidelines for conducting quality improvement activities in conjunction with the CAHPS Hospice Survey?

It is permissible for patients and/or their caregivers to be asked questions about their care during their hospice stay or during bereavement calls where this is a normal part of quality improvement activities.

Activities and encounters that are intended to provide or assess clinical care or promote patient/family well-being are permissible. If patients or their caregivers are asked questions during their hospice care, we suggest that such questions be worded in a neutral tone and not slanted toward a particular outcome. In addition, questions must not resemble CAHPS Hospice Survey items or their response categories. Hospices should focus on overall quality of care rather than the measures reported to CMS.

Caregivers should not be given any formal, CAHPS Hospice Survey-like, patient experience/satisfaction survey during their family member’s hospice stay or after the death of the patient. A formal survey, regardless of the mode employed, is one in which the primary goal is to ask standardized questions of a significant portion of a hospice’s patient/caregiver population.

  • When asking non-CAHPS Hospice Survey questions, do not use CAHPS Hospice Survey-like response categories (for instance, “Always,” “Usually,” “Sometimes,” or “Never”)
  • The following are examples of the types of questions that are not permissible:
    • “On a scale of 0 to 10, how would you rate your family member’s hospice care?”
    • “Is there a way we could always….?”
    • “Did the hospice team explain things in a way you could understand?”
    • “Overall, how would you rate the care you received from the hospice?”

Activities and encounters that are primarily intended to influence how caregivers, or which caregivers, respond to CAHPS Hospice Survey items must be avoided.


Why are the scores in the Provider Preview Report lower than those from our survey vendor?

  • The differences you noticed are due to CMA and mode adjustment that are applied to the publicly reported data to make them possible to fairly compare across hospices
  • As a reminder, only CAHPS Hospice Survey measure scores calculated by CMS are official results; results provided by your survey vendor are not official CAHPS Hospice Survey scores. Survey vendors and hospices may closely replicate scores calculated by CMS by following CMS guidance:
  • For details regarding the definition that CMS uses to determine whether a survey is “completed,” please see the "Quality Assurance Guidelines" page for the CAHPS Hospice Survey QAG, Version 8.0, available at http://www.hospicecahpssurvey.org
  • For details regarding the steps that CMS uses to calculate top-box scores, please see the “Scoring and Analysis” page of the CAHPS Hospice Survey website, available at http://www.hospicecahpssurvey.org
    Please note that only responses from caregivers who indicated that their family member received care at home or in an ALF are included in the calculation of the Training Family to Care for Patient measure.
  • CMS adjusts scores for both case mix and mode. To ensure that comparisons between hospices reflect differences in performance rather than differences in patient or caregiver characteristics, CMS adjusts responses for “case mix” (i.e., variations of such characteristics across hospices). CMS also applies survey mode adjustment to adjust responses for the effect of mode of survey administration. CMA and mode adjustment coefficients are available on the “Scoring and Analysis” page of the website.
    For example, the mode adjustment coefficient for the Rating of This Hospice measure is –3.89 for hospices that administer the CAHPS Hospice Survey using the mail-only mode. Therefore, a respondent surveyed using the mail-only mode with a top-box score of 100 on this measure would have his or her score adjusted to 96.11 (i.e., 100 – 3.89). This accounts for the fact that 96.11 is the corresponding expected score for that question had the survey been conducted in telephone-only mode. (As described on the “Scoring and Analysis” page, telephone-only mode is the “reference” mode for calculating mode adjustments for the CAHPS Hospice Survey. Please note that the use of the telephone-only mode as the reference mode does not indicate that this mode is preferable to other approved modes in any way; there is no advantage or disadvantage to fielding in any mode, since the mode adjustment offsets the changes in scores caused by different modes of administration.)
  • You may also watch a video podcast that explains how scores are adjusted at https://hospicecahpssurvey.org/globalassets/hospice-cahps/podcasts/9_cma-and-mode-adjustment.mp4.

 

This page was last modified on 09/23/2021