What Is Patient Experience and How Is It Measured?

Patient Experience

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.