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The Adult version of the CAHPS Hospital Survey (HCAHPS) asks people 18 and older about their experiences with care provided in an inpatient setting.

The Centers for Medicare & Medicaid Services (CMS) implements the Adult version of HCAHPS on a national basis. As of January 2022, 4,489 hospitals across the country were using this survey and reporting data to CMS.¹

The Adult HCAHPS Survey and administrative guidelines are available from CMS: . CMS provides . These materials are not available on the ´óÏóÊÓƵ (AHRQ) website.

• For technical assistance, contact the HCAHPS Project Team: hcahps@HCQIS.org or 1–888–884–4007
• For questions about implementation, contact CMS staff: Hospitalcahps@cms.hhs.gov.

Supplemental Items

´óÏóÊÓƵhas developed supplemental items for the Adult version of HCAHPS. The items address two topics:

• Health literacy—These items assess the extent to which professionals in hospital settings are reducing the health literacy demands they place on patients.
• Interpreter services—These items assess patients' experiences with interpreter services in hospitals.

As of January 1, 2025, a maximum of 12 supplemental items may be added to the survey.

CMS's Use of the Adult Hospital Survey

CMS uses the results of this survey in two ways:

• Public reporting: As part of the Hospital Inpatient Quality Reporting program, CMS reports the results of the Adult Survey on . First released in March 2008, these results are updated quarterly.
• Value-based purchasing: As part of the , CMS is adjusting a portion of payments to hospitals based on their performance on the survey and the quality of their clinical care.

Quality Measures from the Adult Hospital Survey

Effective January 1, 2025, the Adult version of HCAHPS produces 11 measures of patient experience: seven composite (multi-item) measures and four single-item measures (including two global ratings). Composite measures combine two or more survey questions that are statistically and conceptually related.

The measures are as follows:

• Communication with nurses (composite measure)
• Communication with doctors (composite measure)
• Restfulness of hospital environment* (composite measure) 
• Care coordination* (composite measure)
• Responsiveness of hospital staff (composite measure) 
• Communication about medicines (composite measure)
• Discharge information (composite measure)
• Cleanliness of hospital environment (single-item measure) 
• Information about symptoms* (single-item measure)
• Quietness of hospital environment (single-item measure)
• Overall hospital rating (global rating; single-item measure)
• Willingness to recommend the hospital (global rating; single-item measure)

*Indicates new measure as of January 1, 2025. A crosswalk of questions from the previous HCAHPS Survey to the updated HCAHPS survey is available at: (240 KB).

Compare Hospital Survey Data

Comparative information for the Adult Hospital Survey is available at the national level as well as for some States and communities. Sources of comparative information for the CAHPS Hospital Survey include the following:

• HospitalCompare: The Centers for Medicare & Medicaid Services (CMS) Web site presents average scores for all hospitals in the nation and all hospitals in a given state.
• Summary Analyses: CMS also provides for current and historic Hospital Survey results.
• Local and Regional Reports: Many organizations produce public reports that show survey results for hospitals at the local or State level.

Brief History

Beginning in 2002, CMS partnered with the ´óÏóÊÓƵ (AHRQ) to develop and test a survey of patients' experiences with hospital care. ´óÏóÊÓƵcarried out a rigorous scientific process, including a public call for measures; a literature review; cognitive interviews; consumer focus groups, stakeholder input, a three-state pilot test, extensive psychometric analyses, consumer testing, and numerous small-scale field tests. During this process, CMS provided three separate opportunities for the public to comment on HCAHPS and responded to well over one thousand comments.

The CAHPS Hospital Survey was first endorsed by the National Quality Forum (NQF) in May 2005. In December 2005, the federal Office of Management and Budget gave its final approval for the national implementation of HCAHPS for public reporting purposes. CMS implemented the HCAHPS survey in October 2006, and the first public reporting of HCAHPS results occurred in March 2008. In January 2015, NQF renewed its endorsement of the CAHPS Adult Hospital Survey. 

In addition to revised survey content, in 2025 CMS made several important changes to survey administration, including: 

• Three new modes of survey administration: Web-Mail, Web-Phone, and Web-Mail-Phone 
• Mail Only, Phone Only, and mixed Mail-Phone modes remain available, though the Interactive Voice Response (IVR) mode is discontinued 
• Official Spanish translation must be administered to all Spanish-preferring patients 
• Maximum of 12 supplemental items may be added to the survey (formerly unrestricted) 
• Proxy respondents not prohibited from answering survey for patients (formerly prohibited) 

The survey, its methodology, and the results it produces are in the public domain.

Learn more about the development of the CAHPS Adult Hospital Survey.

^1. HCAHPS Fact Sheet, January 2025. . Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed January 2, 2025. Available at (396 KB).