HCAHPS (Patient Experience Survey)

HCAHPS, said "H-caps," is the national survey Medicare requires hospitals to send to a random sample of discharged patients. It asks about the things a patient can actually judge: whether nurses and doctors communicated clearly, whether pain was managed, whether the room was clean and quiet, whether medications were explained, whether discharge instructions made sense, and whether the patient would recommend the hospital. The results are published for every hospital, and they make up about a fifth of the CMS star rating.

I pay attention to HCAHPS because communication predicts outcomes. Hospitals where patients say their medications were explained have fewer readmissions for medication problems. Hospitals with high "discharge information" scores send people home who know what to do. The national average for "would definitely recommend" is about 70 percent; the best hospitals are in the mid-80s, and there are hospitals in every large city under 55. Two things to keep in mind when reading the numbers. First, they are about the experience of being a patient, not about surgical skill, so a great surgeon can work at a hospital with mediocre scores. Second, small differences do not mean much; a 3-point gap is noise, a 20-point gap is not. Surgery centers have their own version, OAS CAHPS, which TruePrice uses in its facility quality scores.

The takeaway: look at the HCAHPS "would recommend" and "discharge information" scores for any hospital you are considering. Low scores on those two are a sign that you will need to advocate for yourself more than you should have to.