Patient experience (PEX) encompasses all patient interactions with a healthcare system, including care from health plans and from doctors, nurses, hospital staff, physician practices, and other healthcare facilities. Not to be confused with patient satisfaction, patient experience focuses on how a patient experiences or perceives key aspects of care, including receiving timely appointments, easy access to health information, and effective communication with providers.
How is Patient Experience Measured?
While there are many ways to capture information on patient experience, the Centers for Medicare and Medicaid Services (CMS) use Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, developed by the Agency for Healthcare Research and Quality (ARHQ), to measure a patient’s experience with doctors, hospitals, health plans, and other healthcare entities such as home health agencies or skilled nursing facilities. CAHPS® is the gold standard for measuring patient experience and captures the patient’s voice in different healthcare settings using a standardized methodology.
| CAHPS Survey Categories |
| Getting Needed Care |
| Getting Appointments & Care Quickly |
| Customer Service |
| Rating of Healthcare Quality |
| Rating of Health Plans |
| Care Coordination |
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
In value-based care, patient experience is often a component of quality programs. These components, such as Getting Needed Care, Getting Care Quality, Getting Timely Appointments, Care, & Information, Care Coordination, Doctor/Other Health Provider Patient Conversations, and Overall Provider Rating, can substantially contribute to overall quality performance.
In addition to CAHPS®, the Health Outcomes Survey (HOS) gathers patient experience data in Medicare Advantage programs. This survey evaluates:
| HOS Survey Categories |
| Physical Health Outcomes Measures |
| Mental Health Outcomes Measures |
| Urinary Incontinence in Older Adults |
| Physical Activity in Older Adults |
| Fall Risk Management |
| Osteoporosis Testing in Older Women |
Why does Patient Experience Matter?
CAHPS® surveys are used in value-based programs including:
- CMS Value-based Programs (Hospital Value-based Purchasing, Medicare Shared Savings, and Alternative Payment Models)
- Medicare Advantage Payer Quality Programs
- Commercial Payer Quality Programs
- Medicaid Quality Programs
The results of these surveys are used in value-based payment, public reporting, healthcare accreditation, recognition and certification, quality programs, and research. Like CAHPS®, HOS results are used for program oversight, quality improvement, value-based payments, public reporting, and improving health outcomes.