HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
HCAHPS is the national survey CMS uses to collect and publicly report how patients experienced their hospital stay, including how the hospital's clinicians communicated with them. The National Quality Forum endorsed the survey in May 2005, results appear on Care Compare, and they feed the Hospital Value-Based Purchasing program. Two of its publicly reported sub-measures are communication composites: Communication with Nurses and Communication with Doctors each combine three items asking how often staff treated the patient with courtesy and respect, listened carefully, and explained things in a way the patient could understand.
Source: CMS HCAHPS, Crosswalk of Updated HCAHPS Survey Questions into Publicly Reported Sub-Measures
The communication composites are three questions each, and reading them plainly is the fastest way to understand what the survey rewards. For nurses: during this hospital stay, how often did nurses treat you with courtesy and respect, how often did nurses listen carefully to you, and how often did nurses explain things in a way you could understand. The doctor composite asks the identical three questions about doctors. Nothing in either composite asks about clinical accuracy, so what a hospital is being scored on there is respect, listening, and whether an explanation worked.
The payment weight is real and it sits mostly on communication. Medicare withholds 2% of base operating payments and redistributes about $1.7 billion a year through value-based purchasing, patient experience is 25% of that score (CMS FY2026 IPPS final rule), and five of the eight HCAHPS measures Medicare pays on are communication measures, roughly 15.6% of a hospital's total value-based purchasing score (CMS).
The survey itself is changing. CMS has published a crosswalk mapping the updated HCAHPS questions into the sub-measures that will be publicly reported on Care Compare and the Provider Data Catalog beginning with the October 2026 refresh, and the updated set adds sub-measures for Care Coordination and Restfulness of Hospital Environment alongside the existing composites. The three nurse communication items and the three doctor communication items carry through unchanged, which is a useful signal about how stable CMS considers that part of the instrument.
What HCAHPS cannot do is tell a hospital which clinician needs coaching. A patient answers about the whole stay, weeks after discharge, and the result arrives as a unit or hospital score rather than an individual one. That is one reason the domain has been so hard to move: doctor communication rose 0.8 points from 2008 to 2019, the smallest gain of any HCAHPS domain (Beckett et al., Medical Care 2024), and that study does not establish why. A program that wants to act on the score needs a separate, per-clinician way to see and coach the behavior the survey is asking patients about.
What this looks like in a program
- Hospitals that map their communication training to the six composite items can say which of the three behaviors, respect, listening, or explaining, each session actually rehearsed.
- HCAHPS is a program-level signal on a lag, so pairing it with a per-clinician practice record is what makes it coachable.
- No training vendor, ClinicalSim included, should promise a score change. Scoring a conversation against a published communication framework is not a prediction of a survey result.
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Last updated August 2026