Countdown to the Updated Hospice CAHPS Survey
The clock is ticking towards the launch of the updated hospice CAHPS survey. Will your CAHPS vendor be ready? The Centers for Medicare and Medicaid Services (CMS) finalized the implementation of a revised hospice CAHPS survey in the FY 2025 final payment update rule. The updated survey will begin with April 2025 decedents and allow for web-mode consumer completion. It is shorter and simpler than the current survey and includes new questions on topics suggested by stakeholders.If you have not communicated with your CAHPS vendor thus far, you should contact them to ensure they will be ready for the implementation date. Administration for April 2025 decedents is not slated to begin until summer 2025, allowing ample time for vendors to program and prepare materials. The updated survey instrument is titled, QAG V10.0 Survey Materials, and is available in multiple languages at https://www.hospicecahpssurvey.org/en/survey-materials/mail-materials/.
Updated Survey Essentials
Web-mail mode administration
CMS finalized the addition of a web-mail mode (email invitation to a web survey, with mail follow-up to non-responders); to add a pre-notification letter; and extended the field period from 42 to 49 days, beginning with April 2025 decedents. The web-mail mode would be an alternative to the current modes (mail-only, telephone-only, and mixed mode (mail with telephone follow-up)) that hospice providers could select. A pre-notification letter will be sent to the designated contact one week before the survey administration. In a 2021 experiment, CMS tested a prenotification letter seven days before survey administration and determined that it was acceptable to caregivers and worked with the timeline for survey administration and data submission1.
Per CMS, hospice providers should check with their current vendor about plans for web-mail mode implementation as it is not required. If your organization wishes to offer surveys via web-mail mode and your current vendor is not planning to implement that mode, you may need to change vendors.
Survey structure changes
The updated survey is shorter with 39 questions than the current 47-question survey. The revised survey contains 30 questions about the hospice care experience and 9 demographic questions. Finalized changes to the survey and the quality measures derived from testing also include1:
- Removal of three nursing home items and an item about moving the family member that is not included in scored measures
- Removal of one survey item regarding confusing or contradictory information from the Hospice Team Communication measure
- Addition of two new items, which will be used to calculate a new Care Preferences measure
- Simplified wording to component items in the Hospice Team Communication, Getting Timely Care, and Treating Family Member with Respect measures
Survey measures update
CMS developed a new CAHPS measure and updated two CAHPS measures related to revising the overall survey. The new Care Preferences measure, the revised Hospice Team Communication measure, and the revised Getting Hospice Care Training measure received endorsement through the Consensus Standards Approval Committee (CSAC) in Fall 2022. The Care Preferences, Hospice Team Communication, and Getting Hospice Care Training measures were on the CMS 2023 Measures Under Consideration list (MUC) and evaluated by the Pre-Rulemaking Measure Review (PRMR) Post-Acute Care/Long-Term Care (PAC/LTC) Committee1. Let’s take a look at each measure to understand how they fit into the revised survey.
- CMS added two new items to the survey which will be used to calculate a new Care Preferences measure. There is no such measure on the current CAHPS survey. The items are related to respecting patient wishes and listening to what matters to the patient. See the new survey measure items below1:
| Current CAHPS Survey | Revised CAHPS Survey |
| N/A (not on current survey) | “Did the hospice team make an effort to listen to the things that mattered most to you or your family member?” |
- CMS simplified the wording to component items in the Hospice Team Communication measure as follows1:
| Measure | Current CAHPS Survey | Revised CAHPS Survey |
|---|---|---|
| Hospice Team Communication | “While your family member was in hospice care, how often did the hospice team keep you informed about when they would arrive to care for your family member?” | “How often did the hospice team let you know when they would arrive to care for your family member?” |
| “While your family member was in hospice care, how often did the hospice team explain things in a way that was easy to understand?” | “How often did the hospice team explain things in a way that was easy to understand?” | |
| “While your family member was in hospice care, how often did the hospice team keep you informed about your family member’s condition?” | “How often did the hospice team keep you informed about your family member’s condition?” | |
| “While your family member was in hospice care, how often did anyone from the hospice team give you confusing or contradictory information about your family member’s condition or care?” | N/A (removed from revised survey) | |
| “How often did the hospice team listen carefully to you when you talked with them about problems with your family member’s hospice care?” | “How often did the hospice team listen carefully to you when you talked with them about problems with your family member’s hospice care?” | |
| “While your family member was in hospice care, how often did the hospice team listen carefully to you?” | “While your family member was in hospice care, how often did the hospice team listen carefully to you?” |
- CMS simplified the wording to component items in the Getting Timely Care measure. as follows1:
| Measure | Current CAHPS Survey | Revised CAHPS Survey |
|---|---|---|
| Getting Timely Care | “How often did you get the help you needed from the hospice team during evenings, weekends, or holidays?” | “How often did you get the help you needed from the hospice team during evenings, weekends, or holidays?” |
| “While your family member was in hospice care, when you or your family member asked for help from the hospice team, how often did you get help as soon as you needed it?” | “When you or your family member asked for help from the hospice team, how often did you get help as soon as you needed it?” |
- CMS simplified the wording to component items in the Treating Family Members with Respect measure as follows1:
| Measure | Current CAHPS Survey | Revised CAHPS Survey |
| Treating FamilyMember with Respect | “While your family member was in hospice care, how often did the hospice team treat your family member with dignity and respect?” | “How often did the hospice team treat your family member with dignity and respect?” |
| “While your family member was in hospice care, how often did you feel that the hospice team really cared about your family member?” | “How often did you feel that the hospice team really cared about your family member?” |
Impact on CAHPS Star Ratings
There were no changes to the CAHPS Star Rating methodology in the FY 2025 final payment update rule. However, because a new CAHPS measure was developed and others were changed, the impact on Star Rating impact was reviewed. It was determined that since “Care Preferences” is a new measure, CMS would wait to introduce public reporting until there are eight-quarters of data.
The one summary item change to the “Getting Hospice Care Training” measure was viewed as substantive and will be treated as a new measure for public reporting. CMS will not publicly report the new version of “Getting Hospice Care Training” until eight quarters of data are collected.
Revisions to the “Hospice Team Communication” measure were viewed as not meaningfully impacting the measure and it will continue to be publicly reported and used in Star Ratings in the transition period between the current and new surveys1.
In the transition period, CMS will calculate scores, and Star Ratings by combining scores from quarters using the current and new survey. The Family Caregiver Survey Rating Summary Star Rating will be based on seven measures rather than the current eight measures during the interim period until a full eight quarters of data are available for the “Getting Hospice Care Training” measure. The summary Star Rating would be based on nine measures once eight quarters of data are available for the new Care Preference and Getting Hospice Care Training measures1.
CMS anticipates the new measures will be reported in the February 2028 refresh to public reporting on Medicare Care Compare using Q2 2025 through Q1 2027 data. Measure scores and Star Ratings are not calculated on the same schedule, so CMS will make measure scores available to providers confidentially in their Provider Preview reports once they meet a threshold number of completed surveys1.
Starting your preparation now for the updated hospice CAHPS survey ensures implementation success. By proactively understanding the changes to the survey and the new measures being introduced, such as the “Care Preferences” and the revised “Getting Hospice Care Training” measure, you can effectively align your practices to achieve positive scores. By staying ahead and preparing your team, you ensure a smoother transition to the updated CAHPS survey, ultimately leading to more accurate and favorable Scores and Star Ratings for your hospice care services.
- The Centers for Medicare and Medicaid Services. (2024, Aug 6). Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements – Final rule. https://www.govinfo.gov/content/pkg/FR-2024-08-06/pdf/2024-16910.pdf
- The Centers for Medicare and Medicaid Services. (2025, Jan). CAHPS hospice survey: QAG V11.0 survey materials. https://www.hospicecahpssurvey.org/en/survey-materials/telephone-scripts/
