HCAHPS Updates Coming Soon

By David Fetterolf, Stratus Video President

The Centers for Medicare and Medicaid Services (CMS) recently released information surrounding updates to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and quality assurance guidelines. The updates are designed to improve the effectiveness of the data collection process and are set to take effect in October of 2019.

The changes apply to all four modes of survey administration:

  • Mail only,
  • Telephone only,
  • Mixed methodology of mail with telephone follow-up, and
  • Active interactive voice response (IVR).


Protocol for changes to each mode of administration are outlined in the latest version of HCAHPS Quality Assurance Guidelines (V14.0). CMS requests that hospitals refer to the new guidelines for patient discharges beginning October 1, 2019 and forward. The previous version, HCAHPS Quality Assurance Guidelines V13.0, remains available for hospitals to use for patient discharges through September 30, 2019.

HCAHPS updates include the following:

  • The placement of a mandatory transition statement in the survey immediately before any supplemental questions to indicate a transition from the HCAHPS questions to the hospital specific supplemental questions.
  • Revised verbiage in question 29 to include German: “What language do you mainly speak at home? Would you say that you mainly speak English, Spanish, Chinese, Russian, Vietnamese, Portuguese, German, or some other language?”
  • The removal of questions 12, 13 and 14, the three Communication About Pain questions.
  • The renumbering of the remaining questions, resulting in a 29-question HCAHPS Survey.


PDF versions of the updated survey instruments are available for download in English, Spanish, Russian, Chinese, Vietnamese, Portuguese and German on the HCAHPS website.

The Impact of Communication

Communication is a major area of focus on HCAHPS surveys. Five out of nine of the survey’s key components are heavily based on the quality of communication:

  • Doctor communication
  • Nurse communication
  • Staff responsiveness
  • Medication communication and
  • Discharge information


Patients require meaningful access to healthcare information, such as what to expect while in the hospital, health care plans post discharge, medications, doses, and outpatient therapy plans. Without providing quality communication services, HCAHPS scores may suffer.

The Importance of Communication with the limited English proficiency population

Language barriers present challenges for patients, particularly for the limited English proficiency (LEP) and Deaf and Hard of Hearing (HoH) patient population. Without proper access to interpretation and translation services, meaningful communication cannot take place. Considering that there are more than 25 million LEP individuals currently living in the United States, this is a communication segment that cannot be ignored.

The challenges presented to the LEP patient population are numerous. A study published in the Journal of Health Communication revealed that:

  • More than 3X as many LEP patients reported having low health literacy compared to English speaking patients.
  • Nearly half of the LEP patients who reported having low health literacy were also found to be in poor health.


Low health literacy is particularly important to consider during times of transition. Meaningful access to healthcare information at times of transition is essential to patient outcome. Studies show that a lower number of adverse effects and patient readmissions occur with LEP patients when a qualified medical interpreter is used at both check in and discharge.

To improve patient adherence with healthcare plans, any vital written healthcare information, like discharge instructions and prescription information, must also be communicated to patients in their preferred language. Qualified interpreters are trained in both medical terminology and cultural competency to clarify any miscommunication that may arise from cultural differences, including the patient’s level of health literacy.

When an interpreter senses that a patient does not understand a medical term or program, he or she will offer clarification, until meaningful understanding is achieved. For example, an LEP patient receives a diagnosis of diabetes. When the LEP patient has no reaction to the diagnosis, the interpreter asks the patient if he knows what diabetes is. The patient says he is not familiar with the term. The interpreter then defines the medical condition in a meaningful way that the patient can understand. The patient’s understanding of the condition is an essential part of managing it.

In addition to improved patient outcome, the use of qualified medical interpreters has been shown to greatly increase patient perception of care for LEP and Deaf/HoH patients. Satisfaction levels rise significantly when provided an avenue to meaningfully understand medical conditions and diagnoses, healthcare plans and other important information pertaining to health and well-being.

Not only does meaningful understanding greatly increase the patient’s confidence in their care, it also reduces stress stemming from the unknown. Once trust is established between the patient and provider, engagement with LEP patients rises significantly. Patients with access to qualified medical interpreters are more likely to act as active participants in the development of and adherence to their health care plans.

While updates have been made to the HCAHPS survey, great emphasis remains on the quality of communication. As the LEP patient population continues to rise, hospitals and health systems can significantly boost HCAHPS scores of LEP and Deaf/HoH patients by ensuring access to qualified language services. By providing access to all three modes of interpretation and translation services, e.g., video remote, over-the-phone and onsite, hospitals and health systems can ensure meaningful understanding takes place for all patients at all hours of operation.

When it comes to providing quality patient care, assembling a skilled medical team is crucial. Stratus Video interpreters are highly qualified, culturally competent and extensively trained in medical terminology. We offer complete medical language services that include over-the-phone, video remote, and onsite interpretation along with an easy-to-use translation service. Discover how Stratus Video language services can help improve patient satisfaction at your facility.

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