CAHPS Hospice Survey Reporting Guide

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CAHPS Hospice Survey Reporting Guide

CAHPS Hospice Survey Reporting Guide

Hospice leaders often feel the impact of CAHPS Hospice Survey scores long before they feel fully comfortable with how those scores are created and displayed. Families use Care Compare on Medicare.gov to judge your hospice alongside competitors, referral partners quietly watch star ratings, and CMS ties reporting compliance to your annual payment update. Yet the mechanics of how survey data flows from grieving caregivers to a public profile are easy to underestimate.

This guide is meant to slow that process down and provide information regarding CAHPS Hospice Survey reporting, the Hospice Quality Reporting Program, and related federal requirements. We will walk through how the CAHPS Hospice Survey fits within the Hospice Quality Reporting Program (HQRP), how scores are calculated and adjusted, what gets publicly reported on Care Compare, and the practical steps hospices can take to manage both compliance and reputation risk.

The Hospice Quality Reporting Program is mandated by the Affordable Care Act of 2010. Participation in CAHPS Hospice Survey reporting is mandated by federal law to ensure compliance and quality improvement in hospice care.

Our goal is not to turn you into a statistician. It is to give your team enough clarity that CAHPS reporting becomes a manageable, year-round discipline rather than a quarterly surprise.

Where the CAHPS Hospice Survey Fits in HQRP

The CAHPS Hospice Survey is one of the core components of the Hospice Quality Reporting Program. National implementation of the CAHPS Hospice Survey began in January 2015, marking its official rollout as a regulatory requirement for hospice providers across the United States. CMS uses it to capture the voice of family caregivers after a patient’s death, focusing on communication, timeliness, symptom management, and overall experience. The survey is implemented nationally under CMS oversight, using a standardized instrument developed in collaboration with the Agency for Healthcare Research and Quality (AHRQ). The CAHPS Hospice Survey Project, a CMS initiative, was established to improve hospice care quality measurement, response rates, and survey methodology as part of ongoing federal efforts.

More than 4,000 hospice providers across the country participate in this survey. The instrument is administered to primary informal caregivers, typically family members or close friends, of Medicare patients who died while under hospice care. The CAHPS Hospice Survey is a national survey of family members or friends who cared for a patient who died while under hospice care. As a consumer assessment of healthcare and an assessment of healthcare providers, the CAHPS Hospice Survey is part of the providers and systems CAHPS family of surveys. The results serve three purposes at once. They guide beneficiaries and families in selecting a hospice program, support hospice providers in quality improvement and benchmarking, and provide CMS with data to monitor hospice care across markets (AHRQ CAHPS Hospice Survey). The CAHPS Hospice Survey also helps patients and their family members choose the most appropriate hospice care by comparing performance of hospice agencies.

Within HQRP, CAHPS is currently structured as a pay for reporting requirement rather than pay for performance. In practice, this means that compliance is tied to submitting complete and timely survey data. Participation in the CAHPS Hospice Survey is mandatory for every hospice provider with at least 50 survey-eligible decedents/caregivers since 2015, and hospices must use a CMS-approved survey vendor. Hospices that have 50 or more survey-eligible patient/family caregiver pairs in a reference year are required to participate in the CAHPS Hospice Survey in order to receive their full Medicare Annual Payment Update (APU); failure to do so results in a 4% reduction in their annual Medicare payment update. Hospices that fail to meet HQRP reporting requirements risk a reduction in their market basket update, often referred to as the Annual Payment Update (APU) (CMS CAHPS Hospice overview).

For financial planning, this is a critical point. Even though the content of CAHPS scores does not yet directly change your rate per day, your compliance with the reporting program already affects revenue.

Key Features of the CAHPS Hospice Survey

The CAHPS Hospice Survey is a care survey designed to collect feedback on hospice care services from family members. The survey itself contains 47 questions that cover domains that matter deeply to families during and after a hospice stay, focusing on the experience of family members who cared for a patient who passed away while receiving hospice care. CMS publicly reports results as part of Care Compare on Medicare.gov and focuses on eight primary measures built from those questions (CMS CAHPS Hospice Survey description). These domains include communication with family, getting timely help, treating the patient with respect, emotional and spiritual support, help for pain and symptoms, training family to care for the patient, overall rating of the hospice, and willingness to recommend.

Survey administration must follow CMS-approved methods and survey vendors. The CAHPS Hospice Survey is conducted monthly by CMS-approved survey vendors. At this time, there are three approved survey modes. Hospices can use mail-only, telephone-only, or a mixed mode that starts with mail and follows up by telephone for nonrespondents (CMS CAHPS Hospice overview). The survey is sent to the primary caregiver approximately two months after the patient’s death, and a new web-mail mode will be available from 2025. Each mode comes with its own operational considerations, but all must adhere to strict Quality Assurance Guidelines that govern sampling, timing, response tracking, and data submission.

From an operational standpoint, this means that your CAHPS program cannot be an informal add-on. It requires vendor coordination, periodic sampling file preparation from your billing or EMR system, and internal controls to ensure that all required deaths are considered for inclusion according to CMS specifications.

How CAHPS Hospice Results Are Calculated

Once surveys are collected by an approved vendor, the responses move through a standard calculation process that converts raw answers into measure-level scores. Each publicly reported measure is based on specific survey questions, with responses normalized into linear scores that range from 0 to 100. CMS then applies case-mix adjustments to account for differences in patient and caregiver characteristics that may affect survey responses but are outside the hospice’s direct control.

Scores are not based on a single quarter of data. CAHPS Hospice Survey results are calculated using eight rolling quarters of survey responses, which provides stability and reduces the impact of short-term fluctuations. CMS refreshes these measures on Care Compare quarterly. To be included in public reporting, a hospice must have at least 30 completed surveys across the eight-quarter reporting period (Hospice CAHPS public reporting).

This rolling structure has two practical implications. First, improving a score is more like steering a ship than turning a car. Changes you make today will phase into public results gradually as older quarters roll off. Second, once a pattern is visible, it often reflects more than a temporary staffing issue. Families and referral sources will assume persistent trends represent your typical performance unless you communicate otherwise.

Star Ratings and the Family Caregiver Survey Rating

In addition to individual measure scores, CMS publicly reports a CAHPS Hospice Survey Summary Star Rating, known as the Family Caregiver Survey Rating. These stars give a quick summary view of caregiver-reported experience and are displayed on Care Compare for hospices that meet the volume threshold of 75 or more completed surveys during the reporting period.

Star ratings are updated every other quarter and use a detailed statistical methodology to convert measure-level scores into a single 1 to 5 star summary. The methods and national distributions for each refresh period are posted on the official CAHPS Hospice Survey website. For example, CMS publishes technical notes that describe how stars are calculated for specific reporting periods, such as Quarter 2, 2023 through Quarter 1, 2025 (Star Ratings technical notes).

Hospices are given a preview of their upcoming star ratings in official CMS Provider Preview Reports before each Care Compare refresh. This preview period is often the first time leadership sees the downstream impact of earlier operational decisions, so it deserves dedicated attention on your compliance calendar.

Public Reporting on Care Compare

Care Compare on Medicare.gov is the official platform where CMS publicly reports hospice quality data. This includes CAHPS Hospice Survey measures, HIS or HOPE-based clinical measures, and claims-based measures that focus on utilization patterns. All currently active hospices are listed, and the same dataset is also available for download through the Provider Data Catalog (Hospice public reporting background).

For CAHPS specifically, the public reporting schedule follows an established cadence. Measure scores displayed on Care Compare are based on eight quarters of survey data, updated quarterly. Recent CMS communications show that for a May 2026 refresh, CAHPS measure scores will rely on data from Quarter 3, 2023 through Quarter 2, 2025, and CAHPS star ratings will rely on data from Quarter 2, 2023 through Quarter 1, 2025 (Hospice public reporting background).

Importantly, not every measure is permanent. CMS periodically revises the measure set based on policy decisions and technical evaluations. For example, CMS has announced that the CAHPS measure “Training family to care for patient” will be removed from public reporting starting with the May 2026 refresh. That kind of change alters both your quality story on Care Compare and how you prioritize specific caregiver education initiatives.

Provider Preview Reports and Review Requests

Before each quarterly update on Care Compare, hospices have a 30 day provider preview period to review their CAHPS Hospice Survey results. During this window, CMS makes Hospice CAHPS Provider Preview Reports available through the CASPER system within QIES.

These reports present your measure-level scores and, when applicable, your summary star rating as they are scheduled to appear publicly. The intent is to allow providers to verify that the data look reasonable and that there are no obvious anomalies related to vendor submission or CMS processing.

If you believe your CAHPS results are in error, CMS allows hospices to request a review of the calculations. Requests must be submitted during the 30 day preview period and follow a defined email-based process. CMS will not accept review requests after the deadline at 11:59:59 p.m. Pacific time on day 30 of the preview window (CMS CAHPS preview and review process).

In practice, this means your internal reporting workflow needs a reliable trigger. Someone on your team should monitor CMS announcements and the Hospice CAHPS website so that when preview reports are released, your quality, compliance, and leadership teams have immediate access to the data. Waiting until the last week of the preview period leaves little room to validate results or consult with your CAHPS vendor.

CAHPS Reporting and Financial Risk

Although CAHPS Hospice remains a pay for reporting program at this time, hospices cannot afford to treat it as a compliance checkbox. CMS ties market basket updates and the APU to HQRP compliance, which includes successful submission and acceptance of CAHPS data. Missing data or noncompliance can result in reduced annual payment updates, with cumulative effects over time (CMS CAHPS Hospice overview).

Separately, your CAHPS performance affects business relationships in less direct but still material ways. Publicly reported caregiver experience data now drive patient and family decisions, shape referral patterns, and can even influence payer negotiations, particularly in markets with growing managed care penetration. Research using national CAHPS Hospice data has found significant variation in caregiver-reported experiences by profit status, with many for-profit hospices scoring below the national average on key domains (JAMA Internal Medicine study on hospice profit status and CAHPS). That type of research reinforces how closely outside observers watch the public CAHPS dataset.

From our perspective, hospices should treat CAHPS reporting as both a regulatory obligation and a strategic performance indicator. Strong results support sustainable margins in a payment environment that is under regular scrutiny. Weak or declining ratings are an early signal that financial performance could lag peers in future rate-setting cycles.

Operational Foundations for Reliable CAHPS Reporting

Because CAHPS Hospice Survey reporting touches clinical operations, caregiver support, and billing data, the most effective programs build cross-functional routines. In our work with hospice and home health providers, we see several foundational practices that support both compliance and better scores. Collecting family caregiver experience feedback provides hospice agencies with important insights.

First, accurate and timely patient and caregiver data are essential. CAHPS vendors draw their samples from death records, which depend heavily on how your agency maintains beneficiary information, caregiver contact details, and date-of-death data in your EMR or billing system. Incomplete or inconsistent records lead to sampling errors, lower response rates, and potentially biased results. Treat the maintenance of caregiver information as a clinical and compliance priority, not just an administrative task. Hospice agencies required to administer CAHPS Hospice Surveys should consult a CMS-approved survey vendor to implement the survey. The hospice survey project team is responsible for overseeing survey administration and quality, ensuring technical accuracy and compliance with CMS requirements.

Second, survey mode and vendor oversight matter. While CMS defines the approved administration modes, hospices retain responsibility for vendor performance. That means monitoring response rates, reviewing monthly or quarterly interim reports, and confirming that the vendor adheres to the latest Quality Assurance Guidelines Manual. Problems discovered only at the time of public reporting are usually more expensive to fix.

Third, leadership needs regular internal reporting that translates CAHPS results into actionable insights. The raw CMS measures are helpful, but your internal dashboards should go further by trending domains over time, comparing your hospice to state and national averages, and linking experience domains to specific operational metrics. For example, “getting timely help” can be paired with after-hours call response times, on-call staffing, and triage protocols. Insights from CAHPS Hospice Surveys help organizations better address caregiver and patient needs, improving hospice services across the board.

Finally, link CAHPS to broader quality and compliance initiatives. If your hospice is already working through HIS or HOPE metrics and claims-based utilization measures, look for overlapping workflows. Communication, symptom management, and caregiver education are clinical competencies that appear across multiple quality programs. Aligning training, documentation, and audit activities across these measures reduces duplication and makes improvement efforts more sustainable.

Integrating CAHPS with Other Hospice Reporting Requirements

Most hospices are already navigating HIS or HOPE reporting, claims-based quality measures, and cost reporting obligations. Adding CAHPS to that list without coordination creates unnecessary complexity.

A more effective model is to treat HQRP as a single reporting ecosystem. CAHPS Hospice Survey results tell you how caregivers experience the care delivered. HIS or HOPE measures describe whether certain clinical assessments and interventions occurred. Claims-based measures show how that care translated into utilization patterns and site-of-care choices. Together, these data form the quality profile that CMS, families, and referral sources use to understand your hospice.

On the accounting and reimbursement side, this is similar to the role cost reports play in home health and hospice payment systems. Just as Form CMS 1728 20 organizes financial and utilization data to support prospective payment calculations and MedPAC analysis, CAHPS and other HQRP elements organize clinical and experience data to inform quality oversight and potential future payment refinements. In both cases, accurate, timely reporting is a prerequisite for fair reimbursement.

For organizations that already depend on outsourced accounting or compliance support, it can be helpful to extend those relationships to include HQRP monitoring and calendar management. Our previous discussions about the advantages of outsourced accounting and the pitfalls of clinging to in house processes apply here as well. When internal teams are stretched thin, structured external support often makes the difference between bare-minimum compliance and proactive quality management.

If you are working through other hospice quality topics, you may also find it useful to review our outline on hospice claims based reporting under HQRP and our guide to HIS Hospice Item Set reporting. Those resources take a similar approach to the one used here, focusing on the practical steps required to keep reporting aligned with CMS expectations while supporting strategic decision making.

Building a Sustainable CAHPS Reporting Strategy

The most successful CAHPS Hospice programs treat reporting as an ongoing cycle rather than a quarterly scramble. That cycle typically starts with clean underlying data, continues through vendor coordination and internal review of interim survey results, and culminates in a structured review of CMS preview reports and public Care Compare postings.

Over time, hospices that embed CAHPS into their regular quality and financial review meetings find that surprises diminish. Leaders can see trends forming several quarters before they become publicly visible. Clinical and operational teams have clearer targets. And when CMS announces measure changes, such as the decision to remove “Training family to care for patient” from public reporting beginning with the May 2026 refresh, those announcements fit into an existing framework rather than forcing a last minute reaction.

From a risk perspective, this kind of structure also minimizes the chance of missing deadlines for preview report review or for submission of CAHPS data that affect your APU. An internal compliance calendar keyed to CMS’ public reporting schedule, combined with clear task ownership, is often the simplest but most powerful tool in this area.

Conclusion

CAHPS Hospice Survey reporting sits at the intersection of compliance, quality, and financial performance. It translates family caregivers’ experiences into a structured dataset that CMS, beneficiaries, and referral partners use to evaluate your hospice. While the rules and methods behind that dataset can feel technical, the underlying intent is straightforward. CMS wants reliable, comparable information that reflects what matters most to families at the end of life.

By understanding how the survey is administered, how scores and star ratings are calculated, and how those results flow into Care Compare, your leadership team is better positioned to manage both regulatory risk and public reputation. When CAHPS is integrated into broader HQRP efforts and supported with strong internal processes, it becomes less of a compliance burden and more of a strategic asset.

If you would like to discuss how CAHPS Hospice Survey reporting fits within your broader quality and financial strategy, including cost reporting and outsourced support options, we are ready to help. Click the button below to schedule a time to chat.