Testimony to the Senate Subcommittee on Federal Financial Management, Government Information, and International Security
May 15, 2005
by: Elizabeth Wright

Testimony

Mr. Chairman, on behalf Citizens Against Government Waste (CAGW) I am pleased to submit this testimony for the record that expresses our concern about the Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Center for Medicare and Medicaid Services (CMS), developing a voluntary (for now) government-run public opinion survey called the Hospital CAHPS® or HCAHPS.  We are pleased to see you are holding a hearing on this issue.

CAHPS® started out as the Consumer Assessment of Health Plans Survey but has expanded into a series of surveys in several healthcare areas.  The goal of the survey is to measure and standardize patients’ perspectives on their hospital care experience.  But many of the questions that have been formulated over a period of two years are duplicative of the ones found in private sector surveys that hospitals undertake to assure customer satisfaction.  The HCAHPS survey was not required by Congress or the White House and if implemented, will create a new burden on the private sector, and encroach on privately-run patient satisfaction surveys.

AHRQ’s first attempt at designing a survey for HCAHPS consisted of 68 questions that were released in January 2003.  After concerns expressed by hospitals, private surveyors and others that the survey was too long, subjective, cumbersome, and duplicative, a new draft was released in December 2003 that consisted of 32 questions.  This “shorter” version did not solve the problems associated with AHRQ’s first attempt.  The most recent draft consists of 27 questions, which is still too lengthy and asks questions that essentially reproduce ones already asked by private surveyors.  Studies have shown that more is not necessarily better and if the final survey is too repetitive and lengthy, patients will be less likely to respond and the survey will provide little value to hospitals, the health care system and ultimately to consumers.

In addition to these questions being an additional inconvenience for hospitals, it will also be a financial burden.  While implementing CAHPS® has cost taxpayers at least $15 million over a period of five years, the final cost to a hospital for the HCAHPS initiative is unknown.  AHRQ states on its website, “early experience with the CAHPS® survey indicates that interviewing and other data collection costs $25-$40 per completed interview.”

Many private sector surveys exist that consumers can access that would provide information on hospitals such as the annual U.S. News and World Report on top hospitals, the Solucient 100 Top Hospitals, NCR’s Consumer Choice Award, Press-Ganey’s The Compass Awards, and the Distinguished Hospital Award for Clinical Excellence by HealthGrades, to name a few.  In reality, most people choose a hospital facility based on what is recommended by their physician, health insurance plan, and references from family and friends, or what is convenient to their home.

At a minimum, AHRQ needs to dramatically reduce the number of questions it currently has to a small number of summary questions that give an overall grade in certain areas of patient care.  Instead of asking several questions (many of which already exist on private surveys) such as, “how often did the nurse treat you with courtesy and respect,” and “how often did the nurse carefully listen to you,” and “ how often did the nurse explain things in a way you could understand,” AHRQ could ask a broader question on nursing care such as “what is your overall rating of nursing care given at the hospital.”  This modest change would align what AHRQ and patients want to know generally about customer satisfaction with what hospitals are already doing in their private surveys and would create a win-win solution for everyone.

However, the most fundamental question remains: whether customer satisfaction surveys are the business of the government.  In an era of budget contraints, we believe scarce tax dollars could be better spent.  If AHRQ continues down its current path, CAGW fears it will disrupt carefully designed hospital surveys that accurately and efficiently measure the quality of care that was given.  This would be a waste of tax dollars and would not be beneficial to patients.